When discussing the potentials and limitations of “Evidence Based Medicine”, it might be reasonable to begin by examining the premises inherent in the concept. It might be wise to question, for example, whether the use of the word “Evidence” in this model represents an improper appropriation of the term, as if it had a single, specific meaning. One might object: “What is evident? Well, that depends.” (more…)
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…)
Science is a normative enterprise, it should be acknowledged, and this applies just as much to medical research. We need to know how empirical knowledge should be gathered. What methods and techniques should we employ in order for our results to be considered scientific? Indeed, we can think of the term ‘scientific’ as an honorific bestowed upon certain claims when they have been discovered and substantiated in the right way. It is plausible that science is actually constituted by the set of norms for its proper conduct. (more…)
One of the key criticisms of the EBM movement as it has taken shape is that the hierarchies the movement has embraced have placed clinical expertise and localized knowledge at their bottom. This was a reaction to one of EBM’s general aims, to move medicine away from the old habit of simply following authority and into a new era of using good evidence to guide medical decisions. But clinical expertise and blindly following or expressing authority are not the same thing, and I and others think it has been a mistake of EBM to take that assumption and run with it into the arms of the RCT. (more…)
CauseHealth offers a new ontological foundation for medicine, what we call Causal Dispositionalism (Mumford and Anjum 2011). From this perspective, better evidence would mean evidence of causation, understood as something tendential and intrinsic. Specifically, better evidence of causation would involve theoretical understanding of how and why an intervention brings about a certain effect. But we should try to develop this understanding to also include how various factors interact, for instance, what could counteract the effect, what could enforce it and what else is causally relevant for the outcome. (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…)