Dear Ben, Donald and all
My ‘philosophy’ reflects my background I suppose.
What I mean by ‘the truth’ is simply an honest and accurate report of my observations, interpretation and decisions. It is a quality of communication.
II report my observations with a time and place. My brain uses such facts to make predictions with different degrees of certainty (they cannot be ‘true’ predictions, only probable). When a fact is used to make a prediction, it becomes ‘evidence’!
In order to explain these predictions to others I use a ‘model’ based on probability theory (choosing my words depending on the listener). This would be a ‘true’ and transparent explanation.
My decisions are based on the actions that best benefit the patient. ‘Truth’ plays a very secondary role! It is simply a quality of communication.
Does this clarify what I understand by truth and does it coincide with anyone else’s understanding? Do any philosophers hold this view?
Regards
Huw
> On 4 Sep 2019, at 14:55, Donald E. Stanley <[log in to unmask]> wrote:
>
> Dear Ben and Huw,
>
> The question is not really about truth at all
> The attempt to provide a foundation to clinical care cannot be realized for the reason that
> Quine in 1951 demonstrated there are no
> Analytic statements of truth, rather our medical web of belief is altered piecemeal, slowly, based on evidence of mindful changes in diagnosis and treatment. There are no Cartesian truths.
>
> Donald
>
> Dr. Donald E. Stanley FCAP
> Associates in Pathology
> 500 West Neck Road
> Nobleboro, ME. 04555
> [log in to unmask]<mailto:[log in to unmask]>
>
>
> On Sep 4, 2019, at 09:40, Benjamin Djulbegovic MD <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> This message originated outside of MaineHealth. Use caution when opening attachments, clicking links or responding to requests for information.
>
> Huw and colleagues,
> Inevitably this discussion lead us to the question of what is “truth” , an issue that philosophers of science have grappled for a long time. While there are many definitions of the “truth” , in empirical sciences one typically talks about
>
> 1) “correspondence theory of truth,” which assumes that there is “objective reality” and that “truth” is based on the correspondence of ideas, concepts, and theories with facts. When measuring effects of health care interventions, this typically takes a form of measuring outcomes against evidence‐based guidelines. However, as discussed, evidence is often challenged and finding of an incontrovertible “truth” that is uniformly accepted is, in practice, extremely difficult, perhaps impossible.
>
> (physics and natural sciences typically operate within a framework of “correspondence theory of truth “)
>
> 2) the “coherence theory of truth,” according to which statements or judgments are “true” if they cohere with other judgments or statements. (Statistics and mathematics typically rely on “coherence theory of truth”, as often illustrated in Huw’a postings)
>
> We have touched upon this problem in the discussion of overuse and underuse in health care, something often debated on this list and argued that it is impossible to define under-, over- or misuse without reference to a theoretical framework.
> For details, see
>
> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6001794%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=oXJjMUwZkRSo%2F0miBnz5Jy2YgCCiu4WRSfccZWb22I0%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6001794%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=oXJjMUwZkRSo%2F0miBnz5Jy2YgCCiu4WRSfccZWb22I0%3D&reserved=0=>
>
> Hope some philosophers on the list can add more thoughts to this fascinating debate.
>
> Ben
>
>
>
>
>
> On Sep 4, 2019, at 3:54 AM, Huw Llewelyn [hul2] <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> ________________________________
>
> [Attention: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails.]
>
> ________________________________
>
> Dear Kev, Teresa, Ben and everyone
>
> Surely the basis of EBM is evidence-based prediction. If we have evidence that phenomenon A is usually followed by B and B is usually followed by C, we cannot assume that A is usually followed by C. C may never follow A according to the axioms of probability (and simple proportions). All we can do is postulate that A may be followed by C and then test this hypothesis by seeking direct independent evidence that A may often be followed by C.
>
> This is the essence of all scientific hypothesis testing and evidence-based knowledge. Medicine that relies on a hypothesis based on indirect rationale alone without formal direct evidence that supports the final link is not EBM.
>
> The devil lies in the detail of the methods used before they can be accepted by others. Also just because an association exists in the author’s setting, this does not necessarily mean that it exists in the reader’s setting. It should be checked by some form of audit before the supportive evidence might be viewed as adequate.
>
> I would be interested in comments!
>
> Huw
>
>
>
> On 4 Sep 2019, at 10:08, K Hopayian <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Dear Teresa,
> With respect, the question is not what it seems. The language makes it sound like a problem with axioms (you cannot prove an axiom using its own system). But it is not about axioms. EBP is not a method. There are questions about cause and effect that are answerable by empirical methods.
> Example questions:
> If practitioners apply care that is backed by evidence, are outcomes improved?
> If practitioners are taught EBP, can they practice it (does teaching impart knowledge and skills)?
> If practitioners are taught EBP, do they practice it (does training change people)?
> All of these are amenable to empirical studies (observational, interventional).
>
> Dear Juan,
> I have not had time to look at all of your references but I would like to know how you found them. Was it through a systematic search? Could we see your search strategy?
>
> Best wishes,
> Kev
>
> Prof. Kev (Kevork) Hopayian,
> MD FRCGP
> Clinical Professor, University of Nicosia, Cyprus
> RCGP [INT] Member
> Sessional GP, Suffolk
>
>
>
> On 3 Sep 2019, at 21:10, Benson, Teresa <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Can one use the scientific method to prove or disprove the effectiveness of the scientific method?
>
> Teresa Benson
> Sr. Clinical Information Specialist
> Change Healthcare
> 18211 Yorkshire Ave
> Prior Lake, MN 55372
>
> T 952.226.4033
> E [log in to unmask] <mailto:[log in to unmask]>
>
> Confidentiality Notice: This email message and any attachments is for the sole use of the intended recipient(s) and may contain confidential information. Any unauthorized review, use, disclosure or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.
>
>
>
> From: Evidence based health (EBH) <[log in to unmask]<mailto:[log in to unmask]>> On Behalf Of McCormack, James
> Sent: Tuesday, September 3, 2019 4:06 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: (External Email) Re: Without evidence of the impact of EBM (health outcomes)
>
> Except leeches are a treatment. EBP IMHO is a philosophy. How or why would you test a philosophy? Can anyone argue clinicians SHOULDN’T use the best available evidence?
> James
>
>
> On Sep 3, 2019, at 10:47 AM, Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> -very ironic, EBM people asking always "What is the evidence for...?"
> -but you cannot ask them "What is the evidence for EBM helping patients-populations?" because "there is no alternative"
> -even if EBM is harming patients,... Evidence Based Health Care please!
> -leeches were used in medicine from ancient times until the 19th century to draw blood from patients, as appropiate treatment for pneumonia, for example and we abandon it without "asking for alternatives"
> -but probably "leeches people" asked at that time Leeches please!
> -un saludo juan gérvas @JuanGrvas
>
> El mar., 3 sept. 2019 a las 19:20, McCormack, James (<[log in to unmask]<mailto:[log in to unmask]>>) escribió:
> Hi Everyone - Just to throw another wrench in this debate I would like suggest there is no reason to study to see if EBM improves outcomes. In my mind I consider EBM more of a philosophy than a true intervention.
>
> Whether or not EBM impacts health care
>
> 1) health care providers need to be able to appraise an article - at least in a cursory way - and understand the differences between ARR, RRR, NNT, OR etc
> 2) they need to be able to communicate these numbers (when needed) to patients
> 3) guideline writers need to write guidelines that provide clinicians with these numbers in an easy way to understand and use
>
> So, clinicians should be able to use the best available evidence and IMHO for most things "Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice”
>
> Glyn Elwyn and I wrote about this here
>
> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Febm.bmj.com%2Fcontent%2F23%2F4%2F137&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=NtcCmcbZ0HkoblMSEn746Dxc0J7bVzprh2sNKPK%2BVmI%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Febm.bmj.com%2Fcontent%2F23%2F4%2F137&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=NtcCmcbZ0HkoblMSEn746Dxc0J7bVzprh2sNKPK%2BVmI%3D&reserved=0=>
>
> We give an example in this paper where following the best available evidence and doing SDM could worsen outcomes - but that is OK in our opinion.
>
> Would love to hear if people think we are way off base.
>
> James
>
>
>
>> On Sep 3, 2019, at 8:43 AM, Donald E. Stanley <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>>
>> Your opinion is correct. Juan. For every RCT, or meta, there are few guides to talking to patients: how to conduct an appropriate physical examination, when to order tests, the point of the EBM movement was captured in the Sackett phrase ‘best’, ‘judicious’, ‘individual’, all value-laden concepts. No possible RCT could be designed with these outcomes.
>> The clinical encounter is being submerged by evidence!
>>
>> Dr. Donald E. Stanley FCAP
>> Associates in Pathology
>> 500 West Neck Road
>> Nobleboro, ME. 04555
>> [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>
>>
>>
>> On Sep 3, 2019, at 11:16, Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>> wrote:
>>
>> This message originated outside of MaineHealth. Use caution when opening attachments, clicking links or responding to requests for information.
>>
>> -Amy, sorry for not explaining my reason and thanks for your comment
>> -the reason why i posted this is logic, to answer a key question (with kindness and respect):
>> "if the final objective of EBM is to improve patients-populations' health, do we have evidence of succeed in this objective?"
>> -an the answer, sadly, is: NO
>> -i have tried to find the best evidence to answer the question, with four references
>> -if you have better references, or a different answer, please share with me
>> -it is not a question about science and hype, it is a question about the use of resources (time and money) without impact on patients-populations' health
>> -or, worse, is EBM harming patients-populations' health? we don not know
>> -un saludo juan gérvas @JuanGrvas
>>
>>
>> El mar., 3 sept. 2019 a las 16:34, Dr Amy Price (<[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>>) escribió:
>> Dear Juan,
>>
>> Why did you post this? This is biased, divisive, and harmful Juan and uses selective evidence. Evidence Based Healthcare showed me how to critically appraise evidence fairly and how to differentiate science from hype. This listserve is kind to newcomers and shares their expertise freely, they also deserve our kindness and respect. Sharing and explaining the difference between science and hype and showing others where to find evidence has saved many lives in my circles and has made a way for patients to have a better quality future by their own standards. It certainly does not leave patient and public involvement out. Of course there are less than ideal people in every discipline and EBM is not exempt. I am so disappointed by this post and I do not think this angle with these sources is worthy of a debate.
>>
>> Amy
>>
>> From: "[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>" <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>> on behalf of Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>>
>> Reply-To: Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>>
>> Date: Tuesday, 3 September 2019 at 4:10 am
>> To: "[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>" <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]<mailto:[log in to unmask]>>>
>> Subject: Without evidence of the impact of EBM (health outcomes)
>>
>> -should be abandon EBM because its lack of impact (health impact)?
>> -is EBM just an amusement?
>> "None of the studies evaluated health outcomes"
>> What is the evidence that postgraduate teachingin evidence based medicine changes anything? A systematic review.
>> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F1017.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=pv%2BO4Rt11Ok8WFFUt%2FFMmI4bYXeWbkxtkPPoLaLq420%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F1017.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=pv%2BO4Rt11Ok8WFFUt%2FFMmI4bYXeWbkxtkPPoLaLq420%3D&reserved=0=><https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F1017.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189656539&sdata=pv%2BO4Rt11Ok8WFFUt%2FFMmI4bYXeWbkxtkPPoLaLq420%3D&reserved=0=<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F1017.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=KQ%2BFaNQcnsamUbJcM7N1EfpNnx7IrLPo86SSHA7VmMs%3D&reserved=0=>>
>> "Few articles address the impact of teaching EBM on clinical outcomes, and in particular those that matter to patients as well as clinicians. Coomarasamy and Khan did not identify any studies"
>> What has evidence based medicine done for us?
>> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F987.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=xnudNV590uSVD3fw9bdBcOueZoiiZUISdEuWgNRVxDU%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F987.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=xnudNV590uSVD3fw9bdBcOueZoiiZUISdEuWgNRVxDU%3D&reserved=0=><https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F987.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=xnudNV590uSVD3fw9bdBcOueZoiiZUISdEuWgNRVxDU%3D&reserved=0=<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F329%2F7473%2F987.short&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=xnudNV590uSVD3fw9bdBcOueZoiiZUISdEuWgNRVxDU%3D&reserved=0=>>
>> "None of the trials assessed patient-relevant outcomes".
>> Effectiveness of training in evidence-based medicine skills for healthcare professionals: a systematic review.
>> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4820973%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=GagjSXwzUhKpiCn29rZxK8kYepa6WcmDyIqU7pDCAHA%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4820973%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=GagjSXwzUhKpiCn29rZxK8kYepa6WcmDyIqU7pDCAHA%3D&reserved=0=><https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4820973%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=GagjSXwzUhKpiCn29rZxK8kYepa6WcmDyIqU7pDCAHA%3D&reserved=0=<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4820973%2F&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=GagjSXwzUhKpiCn29rZxK8kYepa6WcmDyIqU7pDCAHA%3D&reserved=0=>>
>> What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews.
>> https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0086706&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=bdnFxcAVT%2F5nv1u%2Be1Rs%2FKL29MJ3AQadgplu52DN%2B6E%3D&reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0086706&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=bdnFxcAVT%2F5nv1u%2Be1Rs%2FKL29MJ3AQadgplu52DN%2B6E%3D&reserved=0=><https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0086706&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=bdnFxcAVT%2F5nv1u%2Be1Rs%2FKL29MJ3AQadgplu52DN%2B6E%3D&reserved=0=<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0086706&data=02%7C01%7C%7Cceec78ea133c4e3e25f408d7313f8368%7Cd47b090e3f5a4ca084d09f89d269f175%7C0%7C0%7C637032021189666528&sdata=bdnFxcAVT%2F5nv1u%2Be1Rs%2FKL29MJ3AQadgplu52DN%2B6E%3D&reserved=0=>>
>> -un saludo juan gérvas @JuanGrvas
>>
>>
>> ________________________________
>>
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>>
>> ________________________________
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Prifysgol Aberystwyth www.aber.ac.uk
Prifysgol y Flwyddyn ar gyfer Ansawdd Dysgu - The Times & The Sunday Times 2019.
Aberystwyth University www.aber.ac.uk
University of the Year for Teaching Quality - The Times & The Sunday Times 2019.
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