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 (Author), Hilary Roberts (Author)

 

Many enthusiastic reviews are already posted at AMAZON:

"16 of 19 people found the following review helpful

HASH(0x9ac16120) out of 5 stars 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 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 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 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 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 HASH(0x9aa79c48) out of 5 stars

 

 

 

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

Email: [log in to unmask]