“...science is an approach to truth seeking and sensemaking, while evidence-based medicine may operate under the basis that the truth or the underlying science has already been settled.”
That’s the crux of it right there for me. And ditto to Joomi’s comment on RCTs. And ditto to your comment on the need for critical thinking skills (there are many skills that need to be learned, but aren’t taught in schools at any level).
Recently I have seen this meme going around which is a spoof of scripture (which I would consider my life verse - it was even my Wi-Fi password) but it says “I can do all things through evidence based best practice which strengthens me” Peer Review 24:7. So yeah, that’s really placing quite a bit of faith in something that could easily fall apart, for example, C-19 vaccines prevent infection 99% of the time .... or perhaps it was actually nearly never. 🤦♀️
LOL. Prasad puts way too much faith in RCTs. He unironically calls them our "north star." Does he really not know the flaws with RCTs, or how often they end up showing contradictory results? No one should be listening to this man.
Isn't it all really about financial incentives? Which is better business
A) to get someone well quickly, easily and cheaply, or
B) to get them dependent in you for ongoing treatment, especially to get them addicted to expensive drugs that they keep having to come back to you for
and
C) isn't it just good business to mandate that people inject themselves with poison that will cause them health problems which they will then come to for treatment for, especially if you've gotten the government to give you blanket immunity. And if unpleasant facts start coming out, at a certain point you can say "oh so sorry we didn't know"when in fact you knew all the time you were poisoning people for profit?
I started Vinay's article and didn't finish. I'm married to a retired family practice physician who was "old" when she went to med school: 35. As such she'd led a life, been a nurses aid, RN, Nurse practitioner before going to med school. Her perspective was/is totally different than most doctors. Its not "evidence based" as that term is used, as that is just a way for pHarma to control the landscape. Instead I'd call it "patient based" medicine, and included herbs and supplements that were derided by her peers, yet over the years have shown to be a valid, even superior outcome based approach.
Medical education is captured by pHarma and is now run by the suits. It is not patient centered. It is pHarma centered. Until that changes people will find alternatives that work better, cheaper. Plus with the b.s. Of the last 3 1/2 years it's obvious that evidence based is just another politically correct narrative.
"A pre-med student turned medical resident who neglects science would fall into the trap of prescribing Molnupiravir without being aware of its mutagenic properties." But they would certainly be experts in "Advancing Inclusive Excellence" and "Achieving Equity and Social Justice." (taken from the Harvard Medical School webpage)
Thanks for taking on this issue. Molnupiravir was a great example of "evidence based" limitations. (Some health systems were able to keep that drug off of the formulary. )
Evidence based medicine can't be evaluated without the framework of knowledge provided by biology, chemistry, and A&P. With a big picture view, your gut will tell you when you're looking at a garbage drug, or a garbage study, or quackery.
People with varying science and math backgrounds were able to give early warning about COVID policies and treatments.
To pick an antihypertensive, you don't want to google match the diagnosis with the drug. What if the patient has more than one problem? If you know the physiology and biochem, you can stack the antihypertensive based on what's causing the hypertension, what's up with patient's heart function, pharmacogenomic parameters, and which drugs they're currently taking.
(The "guidance" on how to choose antihypertensives changes quite often. )
The increasing proportion of medical studies that are later retracted is of huge concern.
Putting 'evidence based' medicine first means that an internist could be replaced by a search engine or an AI.
1) I have experience and education in a specialized field. But I am not a mechanic. I don’t care “how” my car works, I just want it fixed - but I expect the mechanic to know how it works and how to fix it. Post-COVID I trust the mechanic more than the physician.
2) Knowledge of the pre med sciences provides the foundation to understand disease processes. Instead of getting to the root cause of illnesses, medicine either treats SYMPTOMS with whatever medication is “approved”.
3) The goal of EBM originally was to incorporate the best available research, along with clinical experience and patient preference, into clinical practice. Somewhere along the way (ie big pharma) the process turned into a treatment algorithm (leading to corporate sponsored AI “providers.”)
“...science is an approach to truth seeking and sensemaking, while evidence-based medicine may operate under the basis that the truth or the underlying science has already been settled.”
That’s the crux of it right there for me. And ditto to Joomi’s comment on RCTs. And ditto to your comment on the need for critical thinking skills (there are many skills that need to be learned, but aren’t taught in schools at any level).
Recently I have seen this meme going around which is a spoof of scripture (which I would consider my life verse - it was even my Wi-Fi password) but it says “I can do all things through evidence based best practice which strengthens me” Peer Review 24:7. So yeah, that’s really placing quite a bit of faith in something that could easily fall apart, for example, C-19 vaccines prevent infection 99% of the time .... or perhaps it was actually nearly never. 🤦♀️
LOL. Prasad puts way too much faith in RCTs. He unironically calls them our "north star." Does he really not know the flaws with RCTs, or how often they end up showing contradictory results? No one should be listening to this man.
Isn't it all really about financial incentives? Which is better business
A) to get someone well quickly, easily and cheaply, or
B) to get them dependent in you for ongoing treatment, especially to get them addicted to expensive drugs that they keep having to come back to you for
and
C) isn't it just good business to mandate that people inject themselves with poison that will cause them health problems which they will then come to for treatment for, especially if you've gotten the government to give you blanket immunity. And if unpleasant facts start coming out, at a certain point you can say "oh so sorry we didn't know"when in fact you knew all the time you were poisoning people for profit?
I started Vinay's article and didn't finish. I'm married to a retired family practice physician who was "old" when she went to med school: 35. As such she'd led a life, been a nurses aid, RN, Nurse practitioner before going to med school. Her perspective was/is totally different than most doctors. Its not "evidence based" as that term is used, as that is just a way for pHarma to control the landscape. Instead I'd call it "patient based" medicine, and included herbs and supplements that were derided by her peers, yet over the years have shown to be a valid, even superior outcome based approach.
Medical education is captured by pHarma and is now run by the suits. It is not patient centered. It is pHarma centered. Until that changes people will find alternatives that work better, cheaper. Plus with the b.s. Of the last 3 1/2 years it's obvious that evidence based is just another politically correct narrative.
Just sayin
"A pre-med student turned medical resident who neglects science would fall into the trap of prescribing Molnupiravir without being aware of its mutagenic properties." But they would certainly be experts in "Advancing Inclusive Excellence" and "Achieving Equity and Social Justice." (taken from the Harvard Medical School webpage)
Thanks for taking on this issue. Molnupiravir was a great example of "evidence based" limitations. (Some health systems were able to keep that drug off of the formulary. )
Evidence based medicine can't be evaluated without the framework of knowledge provided by biology, chemistry, and A&P. With a big picture view, your gut will tell you when you're looking at a garbage drug, or a garbage study, or quackery.
People with varying science and math backgrounds were able to give early warning about COVID policies and treatments.
To pick an antihypertensive, you don't want to google match the diagnosis with the drug. What if the patient has more than one problem? If you know the physiology and biochem, you can stack the antihypertensive based on what's causing the hypertension, what's up with patient's heart function, pharmacogenomic parameters, and which drugs they're currently taking.
(The "guidance" on how to choose antihypertensives changes quite often. )
The increasing proportion of medical studies that are later retracted is of huge concern.
Putting 'evidence based' medicine first means that an internist could be replaced by a search engine or an AI.
Then...... Garbage in, Garbage out.
Random comment:
1) I have experience and education in a specialized field. But I am not a mechanic. I don’t care “how” my car works, I just want it fixed - but I expect the mechanic to know how it works and how to fix it. Post-COVID I trust the mechanic more than the physician.
2) Knowledge of the pre med sciences provides the foundation to understand disease processes. Instead of getting to the root cause of illnesses, medicine either treats SYMPTOMS with whatever medication is “approved”.
3) The goal of EBM originally was to incorporate the best available research, along with clinical experience and patient preference, into clinical practice. Somewhere along the way (ie big pharma) the process turned into a treatment algorithm (leading to corporate sponsored AI “providers.”)
4) Buyer beware
And of course out turns out that Vinay's "article" was a chat AI piece. So I've unsubscribed.