 |
 |
Very relevants comments I didn't have the intention to buy the book. Now I'm certain! thanks Lélia Carvalho pediatrician 2016-08-05 6:53 GMT-03:00 Huw Llewelyn [hul2] <[log in to unmask]>: > I paid for a Kindle version of this book. I found it very difficult to > read and rather disappointing. Although it is written in a very ‘free > flowing’ style, there was no careful and balanced reasoning of the kind > that I would find persuasive. If by ‘evidence’, we mean facts used to > make predictions, then all medical activity (and all other activities) > involving other people has to be ‘evidence-based’ if they are to be able to > disagree or agree to what is being done. The alternative is speculation > with little attempt to engage with reality and authoritarian imposition of > resulting views. I hope that any reader of this will allow me to indulge > in what I think the real issue is with EBM. > > > As it happens, I agree that EBM as it stands is ‘work-in-progress’. It > has a long way to go before it can provide the level of evidence that I > would need as a practising doctor because it only provides strong evidence > to support aspects of medical practice such as RCTS and diagnostic > screening test cut-off points by using the indices such sensitivity, > specificity, likelihood ratios and ROC curves (with inappropriate attempts > to apply these indices to all diagnostic reasoning). > > > My job is to identify the best treatment for the individual patient. The > involves use of differential diagnostic reasoning, diagnostic and treatment > criteria based on symptoms, physical signs and test results expressed as > degrees of severity and other numerical values. Screening and treatment > efficacy is only a part of this. I explain the approach in the Oxford > Handbook of Clinical Diagnosis, using ‘provisional’ information that is > used in day to day medicine. I say ‘provisional’ because little of it is > based on careful scientific evidence yet because ‘EBM’ as currently funded > does not yet address this important aspect of medical care. > > > The individual’s ‘evidence’ (the patient's facts chosen form all those > available to make a prediction or decision) should also be made explicit > when practicing ‘real EBM’. In general, the decision is made > ‘subjectively’ by forming impressions based on the available facts. This > applies to the patient with whom decision is shared as well as the advising > doctor. However if the facts used to make decisions remain hidden, then > they cannot be called evidence, which has to be shared. This can be done > by reflecting and creating an 'evidence-based summary' that specifies the > evidence (symptoms, signs and test results) used to arrive at each > diagnosis and decision in the interests of informed consent and continuity > of care. This is taught in the Oxford Handbook of Clinical Diagnosis. > > > When I raise the inadequacy of current ‘EBM’ for practicing doctors like > me with those who have made a career of ‘EBM’ or who fund it, I am told > that it is not a priority. Some of the ways that ‘EBM’ can be improved > is explained in the final chapter of the Oxford Handbook of Clinical > Diagnosis (which thus contains the evidence in support my views above). I > think that until we move forward in an intelligent and enlightened way, we > will continue to have avoidable over-diagnosis, over-treatment, > under-diagnosis and under-treatment and frustration between who provide > care, receive it and those who fund it. > > > Huw Llewelyn > > > D E H Llewelyn MD FRCP > > Consultant physician in endocrinology, acute and general medicine > > Hon Fellow in Mathematics, Aberystwyth University > > > > ------------------------------ > *From:* Evidence based health (EBH) <[log in to unmask]> > on behalf of David Nunan <[log in to unmask]> > *Sent:* 04 August 2016 14:09 > > *To:* [log in to unmask] > *Subject:* Re: Tarnished Gold: The Sickness of Evidence-based Medicine > > I think Mike has just nailed it! Most likely falls foul of same issue with > most recent critiques I've read = confusing EBHC with EBM. > Look forward to your review Mike. > David > > From: "Evidence based health (EBH)" <[log in to unmask]> > on behalf of Michael Bennett <[log in to unmask]> > Reply-To: Michael Bennett <[log in to unmask]> > Date: Thursday, 4 August 2016 01:31 > To: "[log in to unmask]" <EVIDENCE-BASED-HEALTH@ > JISCMAIL.AC.UK> > Subject: Re: Tarnished Gold: The Sickness of Evidence-based Medicine > > I agree. I have just ordered a copy and will reserve comments until after > I have read the whole, but many of the comments and extracts available > point towards the previously established practice of setting up the straw > EBM man and then giving it both barrels. It is interesting that the authors > did not feel a physician co-author would be a useful addition. > > > > I look forward to seeing if there is any acknowledgement that EBM has a > strong focus on the individual, but have seen no sign so far. > > > > Mike > > > > > > *From:* Evidence based health (EBH) [mailto:EVIDENCE-BASED-HEALTH@ > JISCMAIL.AC.UK <[log in to unmask]>] *On Behalf Of *Moacyr > Roberto Cuce Nobre > *Sent:* Wednesday, 3 August 2016 11:21 PM > *To:* [log in to unmask] > *Subject:* Re: Tarnished Gold: The Sickness of Evidence-based Medicine > > > > the comments suggest that the book may be an accurate shot at the wrong > target, or maybe a stray bullet > > -- > Moacyr > > _______________________________________ > Moacyr Roberto Cuce Nobre, MD, MS, PhD > Equipe de Epidemiologia Clínica e Apoio à Pesquisa > Instituto do Coração (InCor) Hospital das Clínicas > Faculdade de Medicina da Universidade de São Paulo > 55 11 2661 5941 (fone/fax) > 55 11 991 331 009 (celular) > > > ------------------------------ > > *De: *"Nickolas Myles [PH]" <[log in to unmask]> > *Para: *[log in to unmask] > *Enviadas: *Terça-feira, 2 de Agosto de 2016 19:36:51 > *Assunto: *Tarnished Gold: The Sickness of Evidence-based Medicine > Did anyone read this book? I reserve any comments until I read it. Nick > Myles Vancouver (EBHC alumi) Tarnished Gold: The Sickness of > Evidence-based Medicine by Steve Hickey > <https://www.amazon.ca/s/ref=dp_byline_sr_ebooks_1?ie=UTF8&field-author=Steve+Hickey&search-alias=digital-text&text=Steve+Hickey&sort=relevancerank> > (Author), Hilary Roberts > <https://www.amazon.ca/s/ref=dp_byline_sr_ebooks_2?ie=UTF8&field-author=Hilary+Roberts&search-alias=digital-text&text=Hilary+Roberts&sort=relevancerank> > (Author) > > > > Many enthusiastic reviews are already posted at AMAZON: > > "16 of 19 people found the following review helpful > > *HASH(0x9ac16120) out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr>A > comprehensive argument against Evidence-based Medicine Dec 22 2011 > > By Arkadiy Dubovoy - Published on Amazon.com > > Format: Paperback Verified Purchase > > With this book Steve Hickey and Hilary Roberts intend to drive a wooden > stake through the heart of Evidence-based Medicine. The premises of the > book are straightforward: EBM is a marketing ploy; it is irrational and > unscientific; it is authoritarian and legalistic; EBM is cookbook medicine > dangerous to patients' health and wellbeing [p.22]. The authors are > straightforward in their assessment of EBM as an irrational unscientific > tool for political control of medicine. No "but's" and "if's," no excuses, > no redeeming qualities (all right, Epidemiology, this is not your fault, > you are a legitimate field of inquiry, but this monster child of yours > needs to go). > > The arguments are lucid and unequivocal, and the writing is excellent. > There is a very good discussion of statistical probability, Bayesian logic, > heuristics, and general scientific method as applied to medicine. That > alone is worth the price of the book. > > Physicians' criticism of EBM may be perceived as self-serving and biased. > The authors, however, are not medical doctors, and they emphasize > repeatedly that their opinion of Evidence-based Medicine is a point of view > of an educated patient. This should not be ignored. You may or may not > agree with the presented arguments, but if you are a conscientious medical > practitioner, you owe reading this book to your patients. > > 3 of 3 people found the following review helpful > > *HASH(0x9a3d8618) out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr>GREAT > June 17 2014 > > By Faiz Khan MD - Published on Amazon.com > > Format: Paperback Verified Purchase > > Well - I am not quite sure what the negative reviews are about. First my > qualifications: A physician scientist (published and speaker nationally and > internationally) and physician executive, with over 10 years as a program > director in an elite residency program. My areas of focus covered > diagnostic reasoning, epistemology, basic sciences, critical care, analyses > of clinical trials, and medical humanities. Any intelligent physician > begins to intuit what the authors are explicitly stating - perhaps their > use of examples from medical doctrine need a bit more refinement - but the > elucidations of how foundational principles of science are cast aside in > the quest for medical 'progress' is spot on. Fraud, bias, and simple > misapplication of statistical inference is 'prevalent' - and it is a truism > that research agendas are guided by industrial agendas - as are 'best > practices.' Physicians are shaped to become cogs in the finance driven > 'health care delivery industry,' rather than guardians for their patients > medical care. Many folks, (parasites) are able to extract egregious amounts > of money in this industry while, at best contributing little (but usually > detracting from ) access, efficiency or quality of medical care. This book > is a must read for all physicians. > > 1 of 1 people found the following review helpful > > *HASH(0x9a553288) out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr>excellent > book, but may require AI familiarity Aug. 15 2013 > > By Manthano - Published on Amazon.com > > Format: Paperback > > I am about 25% through this book, and their promotion of pattern > recognition (over statistics) seems very sensible. I have a back ground as > an artificial intelligence software engineer, so I appreciate the approach. > "Pattern Recognition AI puts the face back on the statistical patient > entity." > What the authors are saying so far is that the accurate picture of the > individual case cannot be captured by population statistics, because such > measures are just generalizations about large populations, whereas the > challenge of the doctor runs exactly counter to that: find out precisely > what is going on with a particular patient. > So the deductive procedure using general statistics is just, well, wrong. > There is just not enough information contained in statistical measures to > drill down to the individual, because the individual is exactly what is > agglomerated and obliterated by statistics. That's what statistics DOES. > Picture yourself going for a walk, and being concerned that you will meet > a snake on the trail. You have read that there is only a .001% chance of > stepping on a snake, but does that help you avoid one? In the case of a > patient being seen by a doctor, the patient usually has a real complaint. > That already makes him an outlier, outside the glob of statistical > description. The snake is likely on the path. How you should proceed > practically is the subject of this book. > > I am interested in computer diagnostic systems, so this book is > interesting to me. Any practicing doctor should read this, I believe. > Whether docs will be so ill-trained in diagnosis that they cannot determine > a patient's priorities, I don't know, but I strongly suspect an ordinary PC > running simple software will be able to beat a doctor's diagnosis within > the next few years. What will happen at that point, I don't know, but the > image of a railroad train versus an automobile comes to mind. Instead of > being herded into a mass conveyance (modern EB medicine), we can do our own > diagnosis and then seek out friendly physicians to carry out that > individualized therapy. > > 16 of 23 people found the following review helpful > > *HASH(0x9a3c1f78) out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr>Why > Pharmaceutical Medicine Fails to Help People Oct. 26 2011 > > By Andrew W. Saul - Published on Amazon.com > > Format: Paperback > > This important book utterly takes the wind out of the sails of so-called > evidence based medicine, the latest fad of pharmaceutical medicine. I do > confess to being biased, as 1) I am on the editorial board of a nutritional > medicine journal, and 2) I have coauthored two books with Dr. Hickey. > However, I think "Tarnished Gold: The Sickness of Evidence-Based Medicine" > is especially well done, and greatly needed. Look around you: people are > sick and medical costs are through the roof. How should we, and can we, fix > a system like this? What treatments work best? How do we know? There have > been so many conflicting medical studies and equally confusing news reports > about them. We have to be able to make sense of research methods, sample > sizes, statistics, and identify bias. Indeed, it is a daunting task, and > not everyone wants to try. But if you do indeed want to settle matters for > yourself, you need this book. Study significance and analysis and decision > science are not everyone's best friends. This is why it is good that we can > turn to Steve Hickey and Hilary Roberts. They truly are skilled at making > the cloudy and incomprehensible into the clear and very sensible. As I read > through this book, again and again I thought, "So that's how it's done. Of > course." Not only that, the book is not difficult to read, and I think, > very enjoyable with a good sense of humor. But the subtitle tells of the > more serious tale: the evidence-based medical emperor has no clothes. What > Mark Twain said of Wagner's music applies to evidence-based medicine": it > sounds better than it is. Reading this book is worth your time. Well worth > it. > > 1 of 1 people found the following review helpful > > *HASH(0x9a65cc90) out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr>Thorough > deconstruction of EBM. May 14 2014 > > By Richard Amerling - Published on Amazon.com > > Format: Kindle Edition Verified Purchase > > Hi gThis is a lucid and thorough critique of the fad known as EBM. The > authors start by pointing out the obvious fallacy of applying large > population studies to individual patients. They go on to demolish EBM as > inherently unscientific. The book has profound implications for the way > medicine is currently practiced, and proposes common sense solutions. As a > physician, I am now convinced that we must get back to first principles in > medicine, and away from EBM. > > › Go to Amazon.com to see all 15 reviews > <https://www.amazon.ca:443/gp/redirect.html/ref=cm_cr_dp_syn_footer?_encoding=UTF8&location=https%3A%2F%2Fwww.amazon.com%2Fproduct-reviews%2FB00710Y1YI%2Fref%3Dcm_cr_dp_syn_footer%3Fk%3DTarnished%2520Gold%253A%2520The%2520Sickness%2520of%2520Evidence-based%2520Medicine%26showViewpoints%3D1&source=standards&token=661ABEA050EC7ED103349320C53489637F654274>*HASH(0x9aa79c48) > out of 5 stars* > <https://www.amazon.ca/gp/product/B00710Y1YI/ref=cm_cr_dpvoterdr> > > > > > > > > *Nickolas Myles, MD, PhD, MSc, FRCPC* > > *Anatomical pathologist, St.Paul’s Hospital, * > > *Clinical Associate Professor, University of British Columbia* > > *Department of Pathology and Laboratory Medicine* > > *1081 Burrard St, Vancouver, BC, V6Z1Y6* > > > > *Phone (604) 682-2344 x 66038 <%28604%29%20682-2344%20x%2066038>* > > *Email: [log in to unmask] <[log in to unmask]>* > > > > > > > -------------------------------------------------------------------- > Astudio gyda ni yn Aberystwyth - Prifysgol Gyntaf Cymru > https://www.aber.ac.uk/cy/undergrad/ > > Study at Aberystwyth – Wales’ First University https://www.aber.ac.uk/en/ > undergrad/ >