Evidence Based Med — Unintended Consequences

26 Apr

Evidenced based med sounds a positive… but what about the process of evidence gathering. So much of todays med approaches, pharma, devices, and others have a standard disclaimer, It is unknown how ABCDEF works…. The odd thing is, much of legacy pharma, as well as devices have a ton of unknowns. In a lot of cases, its pretty ambiguous as to how really efficaious a specific approach is across the board, much less how well or how not so well something will work for an individual patient. Ie, some patients feel ABCDE is a life saver and massively improves their quality of life, others swear at it and call it dangerous at worst, or a waste of money at best.

>My thinking over the years has evolved to the following… evidenced based medicine will likely send us toward a least common denominator which sort of works for the majority, and leaves everyone else hung out to dry. It makes for nice politics and sound bites, but likely not so great a policy (well economically sure, but public health wise probably not so much). What prompted this post is the following anonymous comment I came across on????Dr Carlat’s blog.

The evidence based movement and pushes toward cookie cutter/manualized treatments are to some degree based on the ease of research. It’s very difficult to research complex spontaneous psychodynamic flavored therapies, compared to more concrete CBT–which I find many say they do, but few really do beyond working on discrete symptom reduction.

I find the field to be becoming the “tower of babel” to some degree based on the economic incentive of people ‘creating new therapies’ and writing books, seminars etc.

Many years ago, I walked into the chiropractic field and found this massive tower of babel… Within the confines of Life College, as I’m sure others experienced at Palmer and others, a gaussian distribution of approaches pretty much gave credence to a somewhat limited number of approaches… that is of course until one runs into colleagues from other schools, who also ascribed to a subset of approaches, albeit completely different ones. The thing was, clinically some patients thrived under ABCD, and some didnt, and the reverse was also true, and no matter what it was a bear and a half to try and sort through. I even found myself ethically questioning the whole profession… but I knew folks were being helped on all sides, but also was not naive enough to realized many were running some pretty massive scams as well.

In a lot of ways, it seems the psych domain parallels many of the same issues in chiro… and had it not been for the medical device act of 1977… no doubt we’d be running into the same issues there. Fortunately, or unfortunately, post 1977, a lot of tech is pretty much off the table, along with the snake oil… Somedays I wonder if maybe the consumer and individual doctor had been left in charge rather than the nanny state…. but alas it is water over the dam at this point.


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