“Evidence based” does not equate with EBM

Finally, some sense. I’m all for the concept of evidence-based, but to completely dismiss other ideas because they are not evidence-based, means that the fact that we are each biochemically different is not considered. To suggest that we all require the same kind of treatment for a particular condition is illogical. Evidnece-based medicine will become truly powerful when it takes into account biochemical individuality. Currently, the way I see it, evidence-based medicine isn’t much more than playing the odds for the most part.

For example, from a nutrition perspective, to suggest that the entire population will become healthy if they actually follow the Food Guide is clearly misguided. Some people, such as fast oxidizers and parasympathetic dominants, achieve their ideal body-weight, lower their markers for disease etc. if they eat a high protein high fat low carb diet, while mixed oxidizers and balanced autonomics need an even mix of the macro-nutrients to be healthy, and slow oxidizers and sympathetic dominants will actually do well on the high carb Food Guide recommendations. It is time to recognize that we are all different biochemically, and food (and drugs) affect each of us differently. It is not the treatment that is important, but rather how the treatment interacts with the metabolism of the individual which will determine whether or not it will work. (This concept works with respect to nutrition, and I would bet that using these metabolic types would work well for drugs too, although if someone eats according to their metabolic type they probably will be healthy enough not to need any drugs.)

Until medical science stops basing its research on the flawed assumption that its subjects are the same biochemically, conclusive results won’t be had. Research needs to study metabolic differences. Rather than throw out the outliers and look at the middle ground, the outliers need to be thoroughly studied so we understand better why they are the exception rather than the rule. Subjects can be placed on a continuum based on metabolic testing, and grouped with those biochemically closest to them, and then treatment protocols can be tried on each group. I’m certain that then we would have more conclusive results, and we would better be able to give appropriate treatments for the individual. Medicine needs to get away from treating disease which is usually a one-size-fits-all kind of treatment, and focus on treating the imbalances in the individual. Then, finally, we will no longer be playing the odds, but rather giving personalized medicine that is geared to the metabolism of the individual. That is when we will truly have evidence-based medicine.

The Dec. 5th Wall Street Journal editorial page has an interesting take on this issue in The Science of Gore’s Nobel by Mr. Jenkins. On a personal note, I was unable to cut and paste due to the inability of the site to remain stable. Heavily edited on my part we have the following.

Moving away from the issue of global warming we find this reference: “..another Nobel, awarded in 2002 to Daniel Kahneman for work he and the late Amos Tversky did on “availability bias,” roughly the human propensity to judge the validity of a proposition by how easily it comes to mind.

Their insight has been fruitful and multiplied: “Availability cascade “ has been coined for the way a proposition can become irresistible simply the media repeating it; “informational cascade” for the tendency to replace our beliefs with the crowd’s beliefs; and “reputational cascade” for the rational incentives to do so.

Here’s exactly the problem that availability cascade pose: What if the heads being counted to certify an alleged “consensus” arrive at their position by counting heads?

It may seem strange that scientist would participate in such a phenomenon. It shouldn’t. Scientist are human; they do not wait for proof; many devote their professional lives to seeking evidence for hypotheses (especially well-funded hypotheses) they’ve chosen to believe.”

Relevant to this discussion is that we see EBM, P4P, and other ideas being promoted by the press, and others with a financial interest, until a consensus is achieved, making any questioning of the concept unacceptable.

In the old days we simply said; if you tell someone, something often enough, they will begin to believe it. Standards and technology will not solve all of our medical ills.

Steve Lucas

I just finished writing a paper on the theoretical applications and the models of DVR or digital video recorders. I submitted it to a program called safeassign which checks for plagiarism. I just thought the owner of this website might find that to be comical.

- Alex