Comments on: Freakology

By: Chris (Dr)

Chris (Dr) — Sat, 09 Jan 2010 02:55:31 +0000

I am going to go out on a limb here … and say … if your job is in the field of research or a science affected my research … then yes … NO ONE knows what they are doing – really. 100% doesn't exist in real life.

Only Dr's must assume a role of teacher of the knowledge we have … if later on down the road this knowledge changes … then we can't hold Dr's responsible for giving out wrong advice.

We all work within a framework and guidelines – unfortunately sometimes these rules get the better of us if we let them wash over our professions.

Isn't the argument or discussion here just a means of venting anger at something we can't really quantify or touch … shoudn't we people be standing up and saying enough is enough this is wrong!
or…
I didn't sign up to do this? I'm going to start my own Colloidal Silver company and education service so that these types of illness never occour in the first place?

My conclusion, people like to fight … every individual knows best.
why not flip these two points upside down and act accordingly to change this ugly fact.

By: dcs

dcs — Fri, 13 Apr 2007 21:54:27 +0000

I hope if dr caligari ever has a compex, life threatening emergency that his/her physician is not a guideline bound hack!

By: Andrew Brown

Andrew Brown — Thu, 12 Apr 2007 22:36:31 +0000

Thank you for this interesting information. So often when we read things in the papers we realise there may be some other angle that we have not been told.
And I entirely agree that guidelines are good servants but bad masters. If an art is a science with more than five variables then medicine is surely still an art.
But here in the UK we GPs (family physicians) are being brought more firmly under the Guideline Grip. A significant portion of our income now depends on our annual Quality & Outcomes Framework score, which derives from computerised proof that we have adhered to certain guidelines. There are a number of problems with this. Sometimes the guidelines are out of date and wrong – thus we are compelled to change antihypertensive medication to ACEi when the patient has CKD, even if they don’t have proteinuria. I believe that this is now thought unnecessary. A lot of effort is required to assiduously record all information, including exemptions where patients fall outside the guidelines. And it focusses our minds on what can be measured, giving us less time to think about the things that cannot. As Einstein pointed out, not everything that counts can be measured.

By: Runawaydoc

Runawaydoc — Thu, 12 Apr 2007 11:15:21 +0000

And, you, Dr. Caligari, seem to epitomize the rigidity of evidence-based medicine which, if left up to you, would destroy the practice of medicine completely. I believe what db was stating was that there has to me some middle ground, some compromising bewteen what the data shows and what is actually happening in the real world of caring for patients. If I understand your position, if you are counselling a patient with an LDL of 180 that he should begin a statin drug, and that patient tells you he really just does not want to take medicines, you would throw your hand up and cry “so be it…have a heart attack or stroke!! There is nothing else I can do for you!!” Dealing with human beings who are capable of making their own decisions, right or wrong, who are capable of changing the variables at will, or who may resist aknowledging the evidence just because they don’t like you telling them what to do, will never allow sole evidence-based medicine to flourish. There is still an art to medicine…something it sounds like you never learned.

By: dr. caligari

dr. caligari — Thu, 12 Apr 2007 02:36:17 +0000

Ahh, but when a healthcare consumer speaks to a doctor, the doctor rarely assumes the “geesh, I’m just doing my best–I’m just a stupid, a-scientific hick” attitude. To the contrary, all too often, the doctor assumes the role of oracle uttering the truth. When the health care consumers asks, is that an evidenced based protocal? or what’s your authority for that claim? doctors rarely react well.

Rather, they claim that their a-scientific hunches and practices should receive deference. Why?

By: Val Jones

Val Jones — Wed, 11 Apr 2007 18:32:50 +0000

I am a strong proponent of evidence-based medicine, but I do think that Dr. Centor makes a good point – clinical trials test outcomes, safety, and efficacy under very controlled conditions. When we prove that a certain medication works under specific circumstances, we can’t know if it also works for patients with other comorbidities or over longer periods of time, etc. That’s why we keep coming up with new data that sheds light on medication use in new, real life scenarios (like antiarrhytmic use, cox II inhibitors, Zelnorm, etc.) We should keep testing, keep studying, keep collecting data… but realize that right now a lot of what we do is based on standards of care and the best plausible practices given complex realities that don’t always bear a 1:1 relationshiop to the research. That doesn’t make us quacks – it just means that we’re doing the best we can, continually improving as more information becomes available.

By: dr. caligari

dr. caligari — Wed, 11 Apr 2007 13:53:30 +0000

To put it mildly, you’re nuts. Of course medicine is complex–so is economics. However, both should be based upon empirically demonstrable truths. Your “oh-it’s-so-complex- impossible-to-reduce-to-rules” attitude about medicine shows you are more of a quack than a scientist. If you believe that we “can never have the necessary evidence to make even a majority of our decisions,” then you concede you have no idea what you’re doing most of the time.

You justify your ignorance with the INCORRECT claims that there is “increasing life expectancy” No there is increasing AVERAGE life expectancy. But, is that attributable to doctors? Show me the proof. I would argue that the kudos belong to the pharmaceutical companies, public sanitation, and improving diets, life-styles.

Oh–but you don’t believe in evidence–so I guess we can’t have a discussion.

You’re why medicine remains a medieval cottage industry