Reflection by Elise Arnaudo on N=1
The N=1 workshop has been a great occasion to reflect on two crucial questions: where does medical evidence come from? and what kind of evidence is useful in clinical practice? This topic has been addressed in a multi-perspective framework, with the participation of clinicians and philosophers. The discussion has been intense and rich and, in my view, it has also witnessed the fruitfulness of the dialogue between medical practitioners and philosophers.
The debate has focused on the meaning of two claims written also on the beautiful workshop t-shirts: Statistics don’t get me and, my favourite one, One size does not fit all. The last is particularly adequate to represent the case of MUS, which are emblematic of the N=1 problem. As already highlighted in the first CauseHealth meeting, the resistance of MUS to standardized approaches is probably due to the fundamental role that the patients’ experiences play in these condition. But MUS are not an exception and neither is their marginalization in medicine, as emerged in several talks at the workshop: in the EBM model, complex chronic conditions do not fit, likewise pregnant women in clinical trials, and psychiatric patients’ voices in the DSM. What in EBM lacks is the complexity and the specificity of the individual, and this makes medical action less effective.