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Shoule we really rely on ‘new discoveries … made by people having non-sense perceptible experiences, "intuitions"’ as suggested by Wouter, or is this a regressive distraction for EBM? Wouter is right to question over-reliance on empirical EBM, but I want to argue that to follow Nagel’s thinking as a way of lending weight to something called intuition is dangerous and risks taking us back to pre-EBM idiosyncratic eminence led medicine. I do agree something like intuition is important and can improve with personal experience (by which I just mean, as a clinician, an ability to always remain aware of the dangers of over-dependence on a heuristic (rule of thmb) approach to decision making and to be able to question scenarios for their satisficing potential and to notice when something doesn’t quite fit)(for a discussion see Dempsey & Bekker, 2002). Nagel (and Steiner’s) philosophys are interesting but I suggest, dangerous for health, they give permission for people to not only question the limits of empirical EBM (a good thing) but also, crucially, gives people permission to think that their thoughts and opinions are just as good as empirical evidence for guiding practice, and example of what is called radical empiricism (or realism)( a bad thing). Before, in this thread, 16th Jan, Allen Shaughnessy quoted from my book (forgive the plug J)(Dempsey, 2018): "Unlike the logical empiricism of EBM, with radical empiricism the subject cannot get to know the world any better by thinking, rationalizing, or calculating on the basis of experiments." (p. 25) … "The radical aspect of radical empiricism is the assumption that *subjective* thought itself, including elite opinion, is an empirical 'experience', or 'fact', and therefore has the same impact on empirical scientific conclusions as *objective* experimental truth." (p 27). Nagel, cited by Wouter, *i*n his philosophy of panpsychism *, **applies the same radical empiricism* promoted by the pragmatist William James (Thomas, 2018). This is a tempting, but I suggest, misguided solution to EBM’s empirical excesses. This brand of post-Cartesian way-of-knowing what is good practice opens the door to evidence-free practice. It implies that we have the power to make the unknowable knowable (such as the specificity of the representation of the borderline between the normal and the pathological as in anticipatory medicine). And, I suggest also that the turn to panpsychism and ‘intuition’ functions as a distraction. The emphasis on the search for *more* knowledge stops us questioning the underlying fundamental social reality of a neoliberal capitalist pragmatism that relentlessly uses empirical EBM to produce new knowledge and interventions decided by interest in limited outcomes (such as, say cancer deaths) and not in collateral harms (such as over-diagnosis). Dempsey, O. (2018). *Anticipation and Medicine: A Critical Analysis of the Science, Praxis and Perversion of Evidence Based Healthcare*. Abingdon, UK: Routledge. Dempsey, O., & Bekker, H. (2002). "Heads I win, tails you lose" - Qualitative study of GPs' decisions about emergency hospital referrals. *Family Practice, 19*, 611-616. Thomas, A. (2018). Intelligibility all the way down: interpreting Nagel's *Mind and Cosmos*. *Klesis Revue Philosophique, 41*, 1-29. Owen On Fri, Feb 22, 2019 at 12:53 PM Wouter Havinga <[log in to unmask]> wrote: > I think the controversy that Huw mentions is probably pointing to the > difference between EBM and EBP (evidence based practice). > Gordon Guyatt suggested that the original model of EBM (where clinicians > appraised evidence) "is dead" and suggests to keep to data from systematic > reviews. > > https://blogs.bmj.com/bmj/2018/09/14/helen-macdonald-should-clinicians-spend-more-time-thinking-about-guidelines-than-evidence > > > But I suppose that in addition to EBM, in EBP there is the liberty to use > more that the 5 senses that are only sensing that what can be counted. > As described in the aforementioned books by Rudolf Steiner and Thomas > Nagel, we also sense that what is coming up in our own being in a nonsense > perceptible way. And we use that together with the patient to come to the > right way forward in the consultation. > > The patient is partner in this, like the HCW, the patient is also trying > to make sense of her/his condition in the overall scheme of things, or call > it working towards an understanding of his or her situation in the greater > scheme of things (the universal "thought content of the world"). > > Coming back to Huw mentioning that in primary care there is less emphasis > on transparent reasoning, my explanation would be the following. > > In primary care I meet people who come in with self diagnosed anxiety, > depression, stress, and physical symptoms related to that. From my point of > view, it usually comes down to the fact that people are dealing with life > events and I help them to get clarity in that respect. > And if things don't resolve over the decades it becomes hospital > medicine? In my opinion hospital medicine, could be seen as physical > problems as a result of life styles that were not conducive to maintaining > health, e.g. cigarettes, overeating, etc. > These coping mechanisms over decades are causing structural damages to the > body and hospital medicine can take a mechanical approach to address the > physical problems. EBM has found treatments that can be effective for > physical problems. > > I am aware that EBM has also found evidence for Mindfulness, CBT and > healthy diets, etc for primary care settings but I suppose, in EBP, in > enthusing patients early on in life for health generating approaches > (salutogenesis) that approach very much depends on the individuality of the > HCW and hence there is no uniform transparent reasoning as every doctor and > patient is different. > > Wouter > > ------------------------------ > > To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following > link: > > https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 > -- New Book by Owen Dempsey: Anticipation and Medicine: A Critical Analysis of the Science, Praxis and Perversion of Evidence Based Healthcare <https://www.taylorfrancis.com/books/9781351374866> Blog: https://myownprivatemedicine.com/ ######################################################################## To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following link: https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1