by Roger Kerry
“N=1” is a slogan used to publicise a core purpose of the CauseHealth project. N=1 refers to a project which is focussed on understanding causally important variables which may exist at an individual level, but which are not necessarily represented or understood through scientific inquiry at a population level. There is an assumption that causal variables are essentially context-sensitive, and as such although population data may by symptomatic of causal association, they do not constitute causation. The project seeks to develop existing scientific methods to try and better understand individual variations. In this sense, N=1 has nothing at all to do with acquiescing to “what the patient wants”, or any other similar fabricated straw-man characterisations of the notion which might emerge during discussions about this notion. (more…)
By Elena Rocca
We often think of the perfect medical research and health care system as a system that puts patient’s care as the final aim of a long process. In a way, this is hardly controversial: patient’s interest must be prioritized over commercial interest, for instance. Research hypotheses, funding, experimental designs ought to be developed with a special consideration that they are meant to be primarily useful for the patient. Important steps are being taken in this direction. (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…)
Karin Engebretsen, Thinking about guidelines:
The question that is still with me after the workshop is how the naturalist paradigm might affect the “political correct” attitude towards patients suffering from medically unexplained syndromes.
If the political decision makers within the medical field believe in the biomedical model as the provider of the best medical practice, their “worldview” will automatically, influence the complete medical system.
The biomedical model excludes psychological and social factors and includes only biological factors in an attempt to understand a person’s medical illness or disorder. Thus, the biomedical model have a limited, reductionist attitude that divide the human body into separate elements focusing on biological factors. Patients often seem to have a unique expression of their symptoms and a unique combination of biological, social and psychological overlapping symptoms. So how do reductionism and dualism affect clinical guidelines and diagnosing related to medically unexplained syndromes?
I see this question as related to ethical issues in medical practice and I hope there will be more focus on this fact as a critical mechanism.
Elena Rocca, Thinking about guidelines:
I was interested in a question that Sietse threw at us many times: what should be the purpose of a guideline? What does “helping to make a good decision” mean?
We got some inputs about it throughout the whole day: it might mean including the patient view, or reporting only the evidence with no recommendation, or giving recommendation but being transparent about which evidence was considered and how it was judged, or again, as Sietse suggested, it might mean to explain what is “to make an inference”, what happens when a clinical decision is made. I was particularly interested in this last suggestion, and I felt it remained a bit “in the air”. Does it mean that we would need a guideline about the decision process? About the implicit and sometimes unaware stand that the clinician takes by valuing one or the other evidence, following the guideline versus personal judgement?
It is an exciting spring for the CauseHealth project. In January, we organised the N=1 workshop here at NMBU. And in May and June our partner institutions will host a conference in Nottingham and a one-day symposium in Madrid. (more…)