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Owen and Juan, Couldn't agree more with your perspectives. Thank you both for your inspiring words and all the references. Luíza 2017-06-20 7:48 GMT-03:00 Owen Dempsey <[log in to unmask]>: > Who could not agree with that Huw. > > > Advice : 'ad vire' - to make see, is the language of experts. And whilst > expertise is important and has a role, maybe our job is also to make > visible what is not so easily seen: to de-mystify, to de-expertise the > consultation, to de-mathematise life, and to challenge advice based on > unproven interventions and to challenge, even attempt to reverse, the dogma > that more is necessarily better. > > > We won't be able to do this unless we understand how capitalism shapes our > values and mindsets. > > > Owen > > > > On Tue, 20 Jun 2017 at 10:50, Huw Llewelyn [hul2] <[log in to unmask]> wrote: > >> Politicians generally listen and react to the views of people. >> Unfortunately it often requires many disasters to make this happen as we >> have discovered recently in London. >> >> They are also influenced by experts who may misguide politicians and the >> public, often because of fixed ideas that are not supported by evidence. >> Surely it is our job to strive to improve the advice given to our patients, >> the wider public and politicians and to warn about the disasters that may >> happen if sensible advice is ignored. >> >> Huw >> >> On 20 Jun 2017, at 09:56, Owen Dempsey <[log in to unmask]> wrote: >> >> >> >> Yes, EBHC methodology may help us guard against quackery but it isn’t >> succeeding very well. And it won’t succeed if it is viewed (theorised, >> taught and practiced) in isolation from the political world. >> >> >> >> As Huw said earlier, EBHC methodology is inadequate when applied to >> diagnosis and the asymptomatic, as in predictive diagnostic processes that >> include screening . And it’s methodology is used (hijacked if you like) and >> ‘shapes’ public opinion through the elitist models promoted by The Chicago >> School of neoliberalism (Nik-Kah, 2016). >> >> >> >> ‘Public opinion … is the work of men like ourselves, the economists and >> political philosophers of the past few generations, who have created the >> political climate in which the politicians of our time must move …’(Hayek, >> F. 1948. ‘Free’ Enterprise and Competitive Order, in Hayek F.A. ed., >> Individualism and Economic Order. Chicago: University of Chicago Press: >> 107–18cited in Nik-Kah, 2016) >> >> >> >> This shapes the mindsets of patients (and experts), that are increasingly >> anxious so that they are increasingly likely to present with symptoms. >> This creates a vicious circle that intensifies harms (as in Esposito 's >> immunisation paradigm(Esposito, 2008)). >> >> >> >> The mathematics of EBHC is unassailable as logic. But the mathematical >> model is inadequate to life itself, as Husserl pointed out in the 1930s: >> >> >> >> ‘But now we must notice something of the highest importance that occurred >> even as early as Galileo: the surreptitious substitution of the >> mathematically substructed world of idealities for … our everyday >> life-world.’(Husserl, 1970, pp 48-49) >> >> >> >> The domination of EBHC by its mathematical basis makes it the perfect >> tool for making life calculable for the market. But it is, after all, only >> a model for life and life cannot be moulded to fit the model. I think the >> crucial flaw of EBHC methodology is that it doesn't have a definition of >> its object, diagnosis. And, as a result, diagnosis and EBHC becomes >> vulnerable to 'the social', capitalism, and its maximalist expert mindset. >> >> >> >> Esposito, R. (2008) The Immunization Paradigm. *diacritics*, 36(2): >> 23-48. >> >> Husserl, E. (1970) *The Crisis of the European Sciences - an >> introduction to phenomenological philosophy*. Evanston: Northwestern >> University Press. >> >> Nik-Kah, E.V.-H., R (2016) The Ascendancy of Chicago Neoliberalism. In: >> S. Springer (ed.) *The Handbook of Neoliberalism*: New York: Routledge. >> >> On Tue, Jun 20, 2017 at 8:01 AM, Huw Llewelyn [hul2] <[log in to unmask]> >> wrote: >> >>> Andre Knottnerus & Peter Tugwell wrote recently that "It is much more >>> productive to recognize that EBM-workers themselves have always been among >>> the first to say that EBM should continuously improve, to figure out how >>> this can be done, and to act upon this, in collaboration with others who >>> want and are able to contribute. >>> >>> >>> Current EBM does not provide evidence for the best findings for use in >>> differential diagnosis (including for screening test results), evidence for >>> the best findings for use in diagnostic criteria or evidence for the best >>> findings for use in predicting which patients will benefit from a >>> treatment. These issues are central to medical science and practice (see >>> https://blog.oup.com/2013/09/medical-diagnosis-reasoning- >>> probable-elimination/ ). >>> >>> >>> I am trying to improve matters by education (see >>> http://oxfordmedicine.com/view/10.1093/med/9780199679867.001.0001/med- >>> 9780199679867-chapter-1 ). Is there anyone in the EBM community who >>> wishes to join me? Are Andre Knottnerus & Peter Tugwell wrong? >>> >>> >>> Huw Llewelyn >>> >>> >>> >>> On 20 Jun 2017, at 01:32, healingjia Price <[log in to unmask]> wrote: >>> >>> Thank you, Craig, well said! >>> >>> >>> >>> Best >>> >>> >>> >>> Amy >>> >>> >>> >>> >>> >>> >>> >>> >>> >>> *From: *"[log in to unmask]" <EVIDENCE-BASED-HEALTH@ >>> JISCMAIL.AC.UK> on behalf of Craig Lockwood < >>> [log in to unmask]> >>> *Reply-To: *Craig Lockwood <[log in to unmask]> >>> *Date: *Tuesday, June 20, 2017 at 12:08 AM >>> *To: *"[log in to unmask]" <EVIDENCE-BASED-HEALTH@ >>> JISCMAIL.AC.UK> >>> *Subject: *Re: Hijacked evidence-based medicine >>> >>> >>> >>> My take on this: >>> >>> Its not EBM that has been hijacked, it was medicine itself, and that >>> happened a long time ago. If anything, I’m of the view that EBM actually >>> has the framework that can assist to remove medicine from the tentacles of >>> vested interests; but that will always be difficult in a field where care >>> provision is based on a quasi-business model. EBM does promote >>> transparency, and has increased the pressure on big pharma to give open >>> access to trial data, these are gains that can be reasonably credited to >>> EBM (or EBHC as I like to call it). >>> >>> >>> >>> My $0.02 >>> >>> >>> >>> Craig >>> >>> Assoc/Prof Craig Lockwood, PhD >>> >>> Director: Implementation Science >>> >>> The Joanna Briggs Institute, >>> >>> *Chair: Implementation Working Group G-I-N* >>> >>> Postgraduate Coordinator: Faculty of Health Sciences, >>> >>> The University of Adelaide, >>> >>> SA 5005 Adelaide >>> >>> T : +61 8 831 36157 >>> >>> e-mail: [log in to unmask] >>> >>> >>> >>> CRICOS Provider Number 00123M >>> >>> ----------------------------------------------------------- >>> >>> This message may contain confidential or legally privileged information. >>> If you think it was sent to you by mistake, please delete all copies >>> >>> and advise the sender. For the purposes of the SPAM Act 2003, this email >>> is authorised by The University of Adelaide. >>> >>> >>> >>> >>> >>> >>> >>> *From: *"Evidence based health (EBH)" <EVIDENCE-BASED-HEALTH@ >>> JISCMAIL.AC.UK> on behalf of Anoop B <[log in to unmask]> >>> *Reply-To: *Anoop B <[log in to unmask]> >>> *Date: *Tuesday, 20 June 2017 at 2:11 am >>> *To: *"[log in to unmask]" <EVIDENCE-BASED-HEALTH@ >>> JISCMAIL.AC.UK> >>> *Subject: *Re: Hijacked evidence-based medicine >>> >>> >>> >>> Thank you Carlos! >>> >>> >>> >>> The conclusion of the article you posted sums it up well" What does not >>> help - as also Ioannidis emphasizes - is making a caricature of EBM and >>> then attacking this on inappropriate grounds. It is much more productive to >>> recognize that EBM-workers themselves have always been among the first to >>> say that EBM should continuously improve, to figure out how this can be >>> done, and to act upon this, in collaboration with others who want and are >>> able to contribute. That is how progress and innovation work. If there is >>> one really big concern, it is that non-evidence-based or even >>> contra-evidence-based approaches are still widely present in ‘fact-’ or >>> ‘evidence-free’ practices, that are not only far from risk- and harmless, >>> but sometimes even advocated, in medicine, society and policy. >>> >>> >>> >>> On Mon, Jun 19, 2017 at 12:07 PM, Carlos A. Cuello Garcia < >>> [log in to unmask]> wrote: >>> >>> There are good comments and an editorial from recognized EBM leaders >>> (Guyatt, Ioannidis, and others) since April 2017 in the JCE: >>> >>> >>> >>> " >>> >>> Evidence-based medicine: achievements and prospects >>> >>> " >>> >>> http://www.jclinepi.com/article/S0895-4356(17)30163-4/fulltext >>> >>> "EBM has not only called out the problems but offered solutions" ....‘Individualized >>> care is in the heart of EBM.' >>> >>> http://www.jclinepi.com/article/S0895-4356(17)30148-8/fulltext >>> >>> >>> >>> >>> >>> -- >>> >>> Carlos A. Cuello, MD, Ph.D.(c) >>> Health Research Methodology Program >>> Department of Health Research Methods, Evidence, and Impact >>> McMaster University. Faculty of Health Sciences >>> HSC-2C, 1280 Main Street West. Hamilton ON Canada L8S 4K1 >>> >>> >>> >>> >>> >>> -------------------------------------------------------------------- >>> Un o’r 4 prifysgol uchaf yn y DU a’r orau yng Nghymru am fodlonrwydd >>> myfyrwyr. >>> (Arolwg Cenedlaethol y Myfyrwyr 2016) >>> www.aber.ac.uk >>> >>> Top 4 UK university and best in Wales for student satisfaction >>> (National Student Survey 2016) >>> www.aber.ac.uk >>> >> >> >> >> -- >> >> >> https://myownprivatemedicine.com/ >> >> >> >> -------------------------------------------------------------------- >> Un o’r 4 prifysgol uchaf yn y DU a’r orau yng Nghymru am fodlonrwydd >> myfyrwyr. >> (Arolwg Cenedlaethol y Myfyrwyr 2016) >> www.aber.ac.uk >> >> Top 4 UK university and best in Wales for student satisfaction >> (National Student Survey 2016) >> www.aber.ac.uk >> > -- > > > https://myownprivatemedicine.com/ >