In article <000301bdfbad$51d6fd80$0bef6f81
@escorpion.uthscsa.edu>, Dr. Scott
Richardson <[log in to unmask]>
writes
>Indeed, I would imagine skeptics might find it very difficult to defend a
>position that clinical practice should NEVER be informed by knowledge from
>one of those sources. Can anyone make a compelling case for abandoning
>forever the use of knowledge gained from basic science research? Can anyone
>seriously defend the position that clinical practice should be carried out
>by folks completely devoid of clinical expertise? Similarly, can anyone
>defend the stance that we should forever ignore the findings of decades of
>clinical care research? Isn't that position extreme?
Loony, I think.
>
>Instead of whether to ever use evidence from clinical care research, don't
>we really want to discuss how to use such evidence wisely, along with other
>knowledge, in caring for patients and/or populations? Isn't EBP/EBHC about
>adding evidence to the mix of things we use to inform our work, rather than
>substituting it for other knowledge?
Yes. However, a traditional medical
approach was to use basic physiology as
top-grade evidence (it must work because
it intervenes in the appropriate
biological pathway, eg infusing albumen
maintains plasma osmotic pressure and will
help to reabsorb fluid into the
circulation). Second came clinical
experience (I've seen people get better
after they got albumen). And, third and
last, came the trials, so ably reviewed in
http://www.bmj.com on 25th July.
AFAIK there never was any empirical
evidence for the relevance of the
postulated physiological mechanism (nor
for the new albumen leak theory, concocted
to account for the meta-analysis results).
Clinical experience simply reflected the
fact that really ill people tend to get
better if you put almost any kind of
physiologically tolerable fluid in. The
meta-analysis was needed to show that some
kinds of fluid are better than others.
To my way of thinking, one of the main
points about EBM is to reverse the
traditional order of priority for
evidence. If I'm a patient, I want the
treatment that seems empirically most
likely to make me better in the long run.
I'll take that any day over the treatment
that my doctor thought might have been
helpful last time. Only as a last resort
would I take the treatment that ought to
work if some smartass theory is correct in
fine detail! That way lies madness - or,
at any rate Benveniste's homeopathic
water, "physiologically impressed" by
email.
--
Richard Keatinge homepage http://www.keatinge.demon.co.uk
Common sense rules - empirical evidence is a very big part of it.
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