Most healthcare professions claim to seek and treat the causes rather than the symptoms of disease. This started as a reaction to the medicine of the nineteenth century, which was still influenced by Humoral Theory and Paracelsus. Treatments were given to counter the symptoms patients were experiencing. Unfortunately, many of the heroic purgative and cathartic potions given, such as calomel, arsenic, mercury and opium, were more harmful than the diseases they were treating. It led Hahnemann, for example, to develop homoeopathy on the opposite principle that substances that caused similar symptoms to the condition and given in small doses were more effective – but that’s another debate. The focus today, apart, perhaps, from in palliative care, is on treating the cause, bypassing symptoms per se, or using them as monitors of healing. (more…)
As a Gestalt psychotherapist, I have seen an increasing number of individuals over the last fifteen years that experience themselves as burned out. This fact has triggered my interest to explore the phenomenon further. Burnout is as a medically unexplained syndrome (MUS). As with other MUS, there is a tendency to assume a narrow perspective to focus on problems related to psyche or soma as pathologies located exclusively within the patient. Research has mainly looked for clear-cut one-to-one relations between cause and effect. These relationships are however difficult to find in complex syndromes. (more…)
The “Better Evidence for Better Healthcare Manifesto” initiative was recently launched by the Oxford Centre for Evidence Based Medicine (CEBM) in collaboration with the British Medical Journal (BMJ).
The manifesto is motivated by a series of problems and blind spots in the implementation of EBM: lack of high quality evidence, systematic research errors, under-reporting of harm, insufficient inclusion of patient’s priorities are some of the issues named by the Manifesto’s promoters. The purpose of the initiative is to spot what could be changed and how, in order to improve the current situation. (more…)
By Elena Rocca
Pharmacology is a complex science that aims to balance harm and benefit of treatments for the individual patient. How should different types of evidence be synthesised in order to optimize this task? Should evidence from randomized trials be prioritized over other evidence, following the EBM model? If not, how can different types of evidence be amalgamated in an alternative way? (more…)
Samantha Copeland, Thinking about guidelines:
I have been interested for a while in how we justify the move from a single case to conducting research on other patients as research participants. For instance, there have been cases where unexpected (positive) results suggest that a novel approach to treating difficult patients may be found: such as the case in Toronto, Canada where electronic stimulation of a patient’s brain had an effect on his memory that suggested a new method for treating Alzheimer’s might be available; or in Bergen, Norway, when a patient with chronic fatigue unexpectedly recovered from her symptoms while undergoing treatment for Hodgkin’s disease. When a decision is made to start research, researchers must justify why they think the observations made of this particular patient could be repeated in others.
I believe this justification process is most simply expressed as an analogy: one argues that this particular patient is like some other patients in the right ways, and so we can reason that the same effects can be caused by the same treatment approaches. Therefore, it is both correct and ethical for research to attempt to recreate the same results by doing the same things to research participants as was done in this one case with this one patient. (more…)
Stephen Tyreman, Thinking about guidelines:
Following on from the stimulating and highly relevant discussion about guidelines, I want to raise the point that there is a political dimension to the guidelines question that can’t be ignored if the CauseHealth project is to have practical relevance. I recognise that the previous discussion was around clinical guidelines such as those produced by NICE, but these cannot be divorced from the broader issue of guidelines as they concern professional regulation. (more…)
Anna Luise Kirkengen, Thinking about guidelines:
I would like to depart from the most common situation in General Practice, namely: encounters with patients who are categorised as presenting multi-morbidity. This is how it is expressed in the medical language. I would try to change this formulation to something like: a GP’s encounter with a person suffering from what medicine conceptualises as a “number of different diseases”, either simultaneously or sequentially, in the same patient. The concept of “different” diseases does not apply when states of bad health are not strictly separable in terms of etiology, pathogenesis, treatment, and prognosis. Then the question is: on which level does medicine differentiate ethology or pathogenesis? If “two” diseases have a pathological characteristic in common, let us say inflammation, are these “two” diseases still “different” — and due to which criteria? (more…)