Gap and others the dangers of evidence based bandwagon

Discussion in 'Fibromyalgia Main Forum' started by simonedb, Feb 28, 2010.

  1. simonedb

    simonedb Member

    I can send whole article if people want it, give me your email, there is controversy in the field of putting all eggs into this basket too. (not dismissing ebt out of hand, has its place, but want to see objective measures used and not hearsay, thats often not done).<

    Prof Dr Ignaas Devisch
    Lange Boomgaardstraat 8
    9000 Ghent
    Accepted for publication: 9 March 2009
    Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on
    ‘evidence’, rather than ‘intuition’. However, EBM’s fundamental distinction between quan-
    titative ‘evidence’ and qualitative ‘intuition’ is not self-evident. The meaning of ‘evidence’
    is unclear and no studies of quality exist to demonstrate the superiority of EBM in health
    care settings. This paper argues that, despite itself, EBM holds out only the illusion of
    conclusive scienti?c rigour for clinical decision making, and that EBM ultimately is unable
    to ful?l its own structural criteria for ‘evidence’.
    Methods Our deconstructive analysis of EBM draws on the work of the French philoso-
    pher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose
    what has been hidden from view. In plain language, we deconstruct EBM’s paradigm
    of ‘evidence’, the randomized controlled trial (RCT), to demonstrate that there cannot
    be incontrovertible evidence for EBM as such. We argue that EBM therefore ‘auto-
    deconstructs’ its own paradigm, and that medical practitioners, policymakers and patients
    alike ought to be aware of this failure within EBM itself.
    Results EBM’s strict distinction between admissible evidence (based on RCTs) and other
    supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition.
    In other words, according to EBM’s own logic, there can be no ‘evidentiary’ basis for
    its distinction between admissible and inadmissible evidence. Ultimately, to uphold this
    fundamental distinction, EBM must seek recourse in (bio)political ideology and an epis-
    temology akin to faith.
    [This Message was Edited on 02/28/2010]
  2. gapsych

    gapsych New Member

    I guess you haven't considered that I have not only read articles like this but have studied alternative medicine as well as EBM.

    Intuition gives us hypothesis. But you still need to apply the "gold standard" of the scientific method.

    The writing in this article is so convoluted it is almost laughable.


    [This Message was Edited on 03/01/2010]
  3. simonedb

    simonedb Member

    Gap, I currently work in the field and appreciate best practice but I also appreciate continuing to be a critical thinker. I am not dismissing your views out of hand, i agree with some aspects of ebt but my concern is that the things like outcome studies etc are pseudo science and what is being called science is just hearsay and that insurance co.s etc will use this "science" to justify not paying for real care. I am not against you, just calling for broad view. We can't always follow the money on here because we don't know who really reps what all the time. Critical thinking.....keep on it.
  4. gapsych

    gapsych New Member

    I guess I am somewhat confused. SBM is a form of critical thinking. It also involves creativity.

    True SBM, since it is evaluated by other professionals is not the same as pseudo science.

    Right now it is the alternative industry that is using pseudoscience. Critical thinking is imperative to combat this.

    EBM has to do with plausibility. Critical thinking used with SBM is useful for not only science but the humanities as well as problem solving techniques.

    Of course it is not that simple but you get the gist of what I am saying.


    ETA What journal is this article posted? Thanks.

    [This Message was Edited on 03/01/2010]
  5. simonedb

    simonedb Member

    Journal of Evaluation in Clinical Practice ISSN 1356-1294
    from last March

    don't get me wrong, I am very interested and supportive of having good science behind treatments, like I said in another thread, I made some poor choices years ago when first got afflicted with whatever it is that is wrong the last 20 years, cfs/fm, and I went to some alternative practitioners that did harm, however, mainstream also did harm, unfortunately, whatever is wrong, this cfs situation, has been poorly understood and the treatments have often caused more harm to me, ssris for example etc yea in retrospect, the things that have done the most harm my insurance probably paid for (surgery, chiropractic)....

    so I am all for research and proof of efficacy and safety

    but this topic just coincidentally came up at a time where we are debating this at work and its a sore point because now it seems some people are jumping on the ebm bandwagon with religious fervor and using things like outcome studies (info based just on patients reports vs stuff like the georgetown studies where they look at our spinal fluid proteins etc) to establish "truth", seems like this always happens, something that is a good idea, like putting more emphasis in practice on evidenced based medicine, can get twisted and misused by some people or corps to justify methods in their own best interest. So I just don't want to see them throw the baby out with the bathwater, ie, just because something isn't rigorously studied doesnt mean it couldnt have value to some people and also how will we leave room for new innovations to be tried if they lock down and say the only practice that can happen is the approved studied ones we won't get new innovations in tx. I guess worst case scenario fear I have is that insurance companies or govmts will push cbt and MI on cfs folks because its ebt and not continue to innovate with fighting infections or viruses etc Its cheaper to pay a therapist to do a few behavioral sessions with a sick patient than pay for 2 years of abx or antbiotics and run a bunch of tests and continue with a lot of medicines etc sort of what they say is happening in England under Wessley. you know 1984, brave new world sorta stuff.

    I will get back to you as I learn more about this debate and formulate my thoughts. Its really wearing on me, the politics in the field and my concerns about ins./govmt trying to marginalize people and the changes proposed for the dsm5 where they want to put so many folks even gulf war syndrome in somatic category, makes my heart heavy, and I want to fight the good fight, but other times when I see the stress on me, I wonder if I should hang it up and retire early for my health, trying to keep balance. So bottom line is just don't want to see science manipulated, but I am all for science, but I have seen alterative methods help some people quite a bit as well, ie some of the stuff Cheney does, I worked with him for year, its not all ebm but helps some people and he does seem brilliant, some of the stuff on the margins today is mainstream practice tomorrow, and I want to leave room for that as well, its starting to feel like there are ebm police, lock step thinking you know, the pendulum always swings too far one side to the other....
    [This Message was Edited on 03/01/2010]

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