Hi
I am not a scientist or a medic, just a reasonably well-informed member of
the public, but I'd like to put a layperson's point of view. Do you think
that Gillian McKeith's "work" does more harm than good? How bad is the
science? I see her helping people to think twice about what they consume
and how they live - maybe she is popular because her method is successful,
people can identify with what she does?
On the faecal examination, shouldn't we all be keeping an eye on what we
pass, for our health's sake. Don't Austrian toilets have a shelf for that
purpose?
I have felt for a long time that TV lets us down generally by promoting
very few programmes which advocate healthy eating, most of the cookery
programmes still use lots of butter, cheese, cream, chocolate etc; at least
she redresses the balance?
best wishes
Sue
At 10:16 15/02/2007, Michael Power wrote:
>Gillian McKeith has been in the news recently --- see story in the
>Guardian www.guardian.co.uk/food/Story/0,,2011095,00.html. Although her TV
>programmes and books may perhaps be better described as bad science than
>as PBM, her case illustrates that profit motivates the miscommunication of
>evidence not only by professionals and the healthcare industry, but also
>by the mass media. TV is primarily concerned with entertainment, so
>Gillian McKeith's TV programmes are as much about entertainment as advice
>on health. (I shall resist the temptation to speculate on the mindset that
>finds examining faeces entertaining, or the mindset that could see in this
>innovation a gap in the entertainment market. Channel Four must be highly
>indignant that they could not patent/copyright the idea and thus prevent
>the BBC from presenting a variation on the theme of faecal examination.)
>The mass media seem quite happy to profit out of the communication of
>unsound advice, as long as the ratings are high.
>
>Does popular science have to be either boring or bad?
>
>Michael
>
>
>On Wed, 14 Feb 2007 16:56:05 -0500, Vinod H. Srihari
><[log in to unmask]> wrote:
>
> >Roy and Paul -
> >
> >I welcome the term PBM. I remember reading something by Dave Sackett some
>years
> >ago remarking on what he called 'Sackettization' or the practice of
>adding the
> >apellation 'evidence-based' to elevate a whole variety of claims with
>little
> >attention to the level of evidence supporting each.
> >
> >In addition to the corrupting influences you point out (money,
>publication bias)
> >I can think of one more pedestrian and perhaps more common source of
>corruption
> >- the therapeutic evangelism of those who develop or have an interest in
> >promoting a particular practice and sytematizing its implementation by
>calling
> >it evidence-based.
> >
> >I am probably going to get in trouble with someone on this list for this
>(please
> >correct me if I am wrong!) but the Substance Abuse and Mental Health
>Services
> >Adminstration (U.S.) website
> >http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/
> >has a list of 'tool kits' to implement a list of Evidence-Based
>Practices. The
> >current list includes everything from Assertive Community Treatment teams
>and
> >Family Psychoeducation (very good evidence) to Integrated Dual Diagnosis
> >Treatment (very underwhelming evidence) and Illness Management and
>Recovery
> >(?evidence).
> >
> >Integrated Dual Diagnosis Treatment is fast becoming an expected standard
>of
> >care in community psychiatry although the evidence for this (as shown in a
> >recent Cochrane review) hardly supports such widespread application. I
>believe
> >this is a case where the evidence itself is preliminary but its
>inappropriate
> >(over)application generates a pseudo-EBP. So there is PEBP in addition to
> >PEBM..!
> >
> >Vinod Srihari, M.D.
> >Assistant Professor
> >Department of Psychiatry
> >Yale University School of Medicine
> >
> >
> >
> >
> >Quoting Paul Glasziou <[log in to unmask]>:
> >
> >>
> >>
> >>
> >>
> >>
> >>
> >> Dear Roy
> >>
> >> Thanks - I think its very helpful that we stay vigilant to problems in
> >> the evidence chain, and the term PBM is a good alert for that. However,
> >> I am quite optimistic, as there have been important changes over the
> >> years. 20 years ago publication bias existed but very few people were
> >> aware of it, and fewer talking about it. John Simes elegantly
> >> demonstrated the problem existed and proposed the key solution - trials
> >> registries[1]. That was 1986, and action has been slow but we are now
> >> moving close to universal registration of trials. Similarly Cindy
> >> Mulrow in 1987 pointed out the unscientific process of most review
> >> articles[2], concluding that "These results indicate that current
> >> medical reviews do not routinely
> >> use scientific methods to identify, assess, and synthesize
> >> information". But the decades since then have seen an enormous leap in
> >> usage and quality of systematic reviews. Of course, there is much more
> >> to do. The recent analysis by Chan and colleagues[3] showed a mismatch
> >> between the outcomes presented in protocols and published reports, but
> >> again access to protocols is improving. So one of the results of EBM
> >> has been to raise awareness of such problems - but problems that had
> >> always existed. So we do need to be critical and vigilant but rather
> >> than despair and give up EBM we should all work towards fixing them.
> >>
> >> Best wishes,
> >>
> >> Paul Glasziou
> >>
> >> 1. Simes RJ. Publication bias: the case for an international registry
> >> of clinical trials. J Clin Oncol. 1986 Oct;4(10):1529-41.
> >>
> >> 2. Mulrow CD. The medical review article: state of the science. Ann
> >> Intern Med. 1987 Mar;106(3):485-8.
> >>
> >> 3. Chan AW, Hrobjartsson A, Haahr MT, Gotzsche PC, Altman DG. Empirical
> >> evidence for selective reporting of outcomes in randomized trials:
> >> comparison of protocols to published articles. JAMA. 2004 May
> >> 26;291(20):2457-65.
> >>
> >>
> >>
> >> I posted this on the Health Care Renewal blog
> >> (http://hcrenewal.blogspot.com/)
> >> and I think it bears re-posting on this email list.
> >>
> >> I understand that Clinical Governance is probably more widely available
> >> across the pond from here....
> >>
> >>
> >>
> >> Clinical Governance, a
> >> respected
> >> but not widely-circulated journal from the UK, just published
> >> an
> >> article (subscription required) entitled
> >> "pseudoevidence-based medicine: what it is, and what
> >> to do about it," written by Health Care Renewal occasional blogger
> >> Dr Wally R Smith. [Smith WR. Pseudoevidence-based meidicne: what it is,
> >> and what to do about it. Clinical Governance 2007; 12: 42-52.] The
> >> article was featured on the publisher's
> >> latest
> >> monthly highlights page.
> >>
> >>
> >>
> >> I read (and commented on) an earlier draft of this article, and was
> >> struck by its use of the term pseudoevidence-based medicine to describe
> >> some of the less healthy trends we have discussed on Health Care
> >> Renewal.
> >> Some key quotes:
> >>
> >>
> >>
> >>
> >> Another, perhaps not new threat to the practice of EBM
> >> [evidence-based medicine] has been discovered -- pseudoevidence-based
> >> medicine (PBM). PBM can be defined as the practice of medicine based
> >> on falsehoods that are disseminated as truth. Falsehoods may
> >> result from corrupted evidence--evidence that has been suppressed,
> >> contrived from purposely biased science, or that has been manipulated
> >> and/or falsified, then published. Or falsehoods may result from
> >> corrupted
> >> dissemination of otherwise valid evidence. These falsehoods, when
> >> consumed as truth by unwitting and well-intentioned practitioners of
> >> EBM,
> >> then disseminated and adopted as routine practice, may well result not
> >> only in inappropriate quality standards and processes of care, but also
> >> in harms to patients.
> >>
> >>
> >>
> >>
> >> EBM rests on the premises of professionalism in science and
> >> medicine.
> >> EBM presumes that evidence is produced by scientists who strive to be
> >> objective. EBM presumes that those producing evidence have no
> >> pre-conceived hopes or goals for what the evidence will show. EBM
> >> presumes that producers of evidence have no stakes in what the evidence
> >> will show. EBM presumes, or at least strives to assure, that the
> >> scientific evidence-production process is free manipulation by people
> >> with vested interests with goals other than improvement in
> >> patients’
> >> mortality, morbidity, or quality of life.
> >>
> >>
> >>
> >>
> >> There are reasons to believe EBM’s presumptions are
>in
> >> question,
> >> and that PBM is a “new” threat to EBM. Only
>two
> >> conditions are
> >> necessary for PBM to flourish. First, one link in the chain of evidence
> >> production, assembly, or dissemination must be purposely corrupted,
> >> resulting from a compromise of professionalism in science and medicine.
> >> Second, the belief must be promulgated that a given piece of evidence
> >> is
> >> true and of the highest quality possible, when in fact it is
> >> tainted.
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> Smith attributed the rise of pseudoevidence-based medicine to the
> >> conflict between the profit motive and physicians' traditional
> >> values.
> >>
> >>
> >>
> >>
> >> By definition, pharmaceutical companies, device
> >> manufacturers, some
> >> health care providers, many insurance providers, and various middlemen
> >> and brokers in health care are in business for a profit. And while the
> >> profit motive is not itself wrong or dangerous, the profit motive is
> >> dangerous when placed in direct competition with protecting and
> >> prolonging human life, the precise business in which health care
> >> stakeholders should be engaged.
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> As they say, "read the whole thing."
> >>
> >>
> >>
> >> And I think that we will find the term pseudoevidence-based medicine
> >> very
> >> useful on Health Care Renewal.
> >>
> >>
> >>
> >> --
> >>
> >> Posted By Roy M. Poses MD to
> >> Health
> >> Care Renewal at 2/12/2007 10:31:00 AM
> >>
> >> Roy M. Poses MD
> >>
> >> Clinical Associate Professor
> >>
> >> Brown University School of Medicine
> >>
> >> <[log in to unmask]>
> >>
> >>
> >>
> >>
> >>
> >> --
> >> Paul Glasziou
> >> Director, Centre for Evidence-Based Medicine,
> >> Department of Primary Health Care,
> >> University of Oxford www.cebm.net
> >> ph +44-1865-227055 fax +44-1865-227036
> >>
> >>
> >>
> >>
> >
> >
> >--
> >Vinod Srihari, M.D.
> >Assistant Professor
> >Department of Psychiatry
> >Yale University School of Medicine
> >
> >Staff Psychiatrist
> >Connecticut Mental Health Center
> >34 Park Street
> >New Haven, CT 06519
> >
> >Office: (203) 974-7816
> >Fax: (203) 974-7502
> >========================================================================
Sue Hall
Research Administrator
HertNet (Hertfordshire Primary Care Research Network Consortium)
CRIPACC (Centre for Research in Primary and Community Care)
University of Hertfordshire
College Lane Campus
Hatfield
Herts
AL10 9AB
Tel: +44 (0)1707 285214
Fax: +44 (0)1707 284137/285995
Email: [log in to unmask]
website: www.health.herts.ac.uk/hertnet
*Please note that I am normally in the office Monday-Thursday.
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