Evidence Based Medicine Quotes

Medicine today, though, as with related fields such as nutrition, is taught mostly untethered from its history. Students are taught what to believe but not always the evidence on which these beliefs are based, and so oftentimes the beliefs cannot be questioned. And

If doctors practiced medicine the way many companies practice management, there would be far more sick and dead patients, and many more doctors would be in jail.

We need to think rationally – all medical treatments need to be based in science and evidence. Facts don’t care about tradition.

In a devastating of example critical thinking gone bad, highly educated, deeply caring parents avoid the vaccinations that would protect their children from killer diseases. I love critical thinking and I admire scepticism, but only in a framework that respects evidence. So if you are sceptical about the measles vaccinations, I ask you to do two things. First, make sure you know what it looks like when a child dies of measles. Most children who catch measles recover, but there is still no cure and even with the best modern medicine, one or two in every thousand will die from it. Second, ask yourself, “What kind of evidence would convince me change my mind about vaccination. If the answer is ‘no evidence could ever change my mind about vaccination,” then you are putting yourself outside evidence-based rationality, outside the very critical thinking that first brought you to this point. In that case, to be consistent in your scepticism about science, next time you have an operation please ask your surgeon not to bother washing her hands.

At school you were taught about chemicals in test tubes, equations to describe motion, and maybe something on photosynthesis – about which more later – but in all likelihood you were taught nothing about death, risk, statistics, and the science of what will kill or cure you. The hole in our culture is gaping: evidence-based medicine, the ultimate applied science, contains some of the cleverest ideas from the past two centuries, it has saved millions of lives, but there has never once been a single exhibit on the subject in London’s Science Museum.

In medicine, brand identities are irrelevant, and there’s a factual, objective answer to whether one drug is the most likely to improve a patient’s pain, suffering and longevity. Marketing, therefore, one might argue, exists for no reason other than to pervert evidence-based decision-making in medicine.

Here we will see that pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on the research and development of new drugs. Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: to distort evidence-based practice.

I am a cuddly atheist... I am against creationism being taught in schools because there is empirical evidence that it is a silly notion... I am passionately concerned about the rise in pseudo-science; in beliefs in alternative medicine; in creationism. The idea that somehow it is based on logic, on rational arguments, but it's not. It doesn't stand up to empirical evidence. In the same way in medicine, alternative medicines like homeopathy or new age therapies – reiki healing – a lot of people buy into it and it grates against my rationalist view of the world. There is no evidence for it. It is deceitful. It is insidious. I feel passionately about living in a society with a rationalist view of the world. I will be vocal on issues where religion impacts on people's lives in a way that I don't agree with – if, for instance, in faith schools some of the teaching of religion suggests the children might have homophobic views or views that are intolerant towards other belief systems... I am totally against, for example, bishops in the House of Lords. Why should someone of a particular religious faith have some preferential treatment over anyone else? This notion that the Church of England is the official religion of the country is utterly outmoded now.

Broken payment models. Because we rely on insurance companies to pay for care, the treatments offered are not necessarily the most effective or those supported by the most current evidence—they’re simply the treatments that insurance companies have agreed to reimburse. This is not evidence-based medicine, it’s reimbursement-based medicine.

Standardized process guidelines belie the complexity of individual patient circumstances, and freeze care delivery processes rather than foster innovation. What is needed is competition on results, not standardized care. What is needed is competition on results, not just evidence-based medicine. There should be no presumption that good quality is more costly.

The lack of definitive answers to questions discussed in this book also reflects the fact that science is an ongoing process in wh ich the most important sign of progress is often that results of an experiment or observational study lead to a new set of questions. This is part of what makes science exciting and rewarding for scient ists, but it entails an important dilemma: how do we make the best pract ical and even ethical decisions based on incomplete scient ific knowledge?

Some have estimated that the pharmaceutical industry overall spends about twice as much on marketing and promotion as it does on research and development. Regardless of how those two figures compare to each other, the fact that they are in the same ballpark gives one pause, and this is worth mulling over in various contexts. For example, when a drug company refuses to let a developing country have affordable access to a new AIDS drug it’s because – the company says – it needs the money from sales to fund research and development on other new AIDS drugs for the future. If R&D is a fraction of the company’s outgoings, and it spends a similar amount on promotion, then this moral and practical argument doesn’t hold water quite so well. The scale of this spend is fascinating in itself, when you put it in the context of what we all expect from evidence-based medicine, which is that people will simply use the best treatment for the patient. Because when you pull away from the industry’s carefully fostered belief that this marketing activity is all completely normal, and stop thinking of drugs as being a consumer product like clothes or cosmetics, you suddenly realise that medicines marketing only exists for one reason. In medicine, brand identities are irrelevant, and there’s a factual, objective answer to whether one drug is the most likely to improve a patient’s pain, suffering and longevity. Marketing, therefore, one might argue, exists for no reason other than to pervert evidence-based decision-making in medicine.

Among the most virulent of all such cultural parasite-equivalents is the religion-based denial of organic evolution. About one-half of Americans (46 percent in 2013, up from 44 percent in 1980), most of whom are evangelical Christians, together with a comparable fraction of Muslims worldwide, believe that no such process has ever occurred. As Creationists, they insist that God created humankind and the rest of life in one to several magical mega-strokes. Their minds are closed to the overwhelming mass of factual demonstrations of evolution, which is increasingly interlocked across every level of biological organization from molecules to ecosystem and the geography of biodiversity. They ignore, or more precisely they call it virtue to remain ignorant of, ongoing evolution observed in the field and even traced to the genes involved. Also looked past are new species created in the laboratory. To Creationists, evolution is at best just an unproven theory. To a few, it is an idea invented by Satan and transmitted through Darwin and later scientists in order to mislead humanity. When I was a small boy attending an evangelical church in Florida, I was taught that the secular agents of Satan are extremely bright and determined, but liars all, man and woman, and so no matter what I heard I must stick my fingers in my ears and hold fast to the true faith. We are all free in a democracy to believe whatever we wish, so why call any opinion such as Creationism a virulent cultural parasite-equivalent? Because it represents a triumph of blind religious faith over carefully tested fact. It is not a conception of reality forged by evidence and logical judgment. Instead, it is part of the price of admission to a religious tribe. Faith is the evidence given of a person’s submission to a particular god, and even then not to the deity directly but to other humans who claim to represent the god. The cost to society as a whole of the bowed head has been enormous. Evolution is a fundamental process of the Universe, not just in living organisms but everywhere, at every level. Its analysis is vital to biology, including medicine, microbiology, and agronomy. Furthermore psychology, anthropology, and even the history of religion itself make no sense without evolution as the key component followed through the passage of time. The explicit denial of evolution presented as a part of a “creation science” is an outright falsehood, the adult equivalent of plugging one’s ears, and a deficit to any society that chooses to acquiesce in this manner to a fundamentalist faith.

In an age of modern evidence-based medicine, it might be thought that magnetic healing would have completely disappeared. Look in any modern bookshop and you will see that this is far from the case. Many have a generously stocked section entitled ‘Mind, Body, Spirit’ (though the classification ‘Utter Nonsense’ might be more appropriate) in which one can find numerous titles discussing magnetic healing or describing the supposed therapeutic power of crystals. In one such volume, I found the assertion (unsupported by any documented scientific evidence) that lodestones can be used to ‘channel energies’ and ‘reduce negativity’, and that they attack certain cancers and can combat diseases of the liver and the blood. Such specious claims would not be out of place in a book from the Middle Ages, but they can be found in books published in the 21st century. Irrationality is alive and well and sold in a bookshop near you.

Evidence based medicine is meant to ensure that quality treatment options are chosen and diagnosis is based on empirical evidence rather than personal assumptions. But this area adapts to changes more slowly than other industries do. For example, after the driverless car developed by Google ran for 1 million miles without incident, car manufacturers such as Volvo announced the inclusion of such algorithms in its future models. For obvious reasons things are a bit slower in healthcare. But soon an ever–increasing gap is going to be too big to cope with.

Rather than measuring results and rewarding excellent providers with more patients, the focus has been on lifting all boats by attempting to raise all providers of a service to an acceptable level. The principal tools have been practice guidelines and standards of care that every provider is expected to meet. Evidence-based medicine is another term for practicing based on accepted standards of care.

When laws are based on ideology and not evidence, and when public health is based on revelation rather than reality, medical care suffers. Both the privacy and sanctity of the doctor-patient relationship are compromised. As noted by U.S. medical specialty societies, intrusion of uninformed lay persons (viz., State legislators) into the practice of medicine is dangerous and unwarranted.

In a medical system based on evidence from trial results, the medicine we end up with depends on the trials that are carried out. So perhaps it’s not surprising that in Western medicine, there is little attempt to nurture and harness patients’ psychological resources. Despite

pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on the research and development of new drugs. Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: to distort evidence-based practice.

Innovations are happening in conventional schooling. Some people will read the chapters to come and respond that their own children’s schools are incorporating evidence-based changes, making them more like Montessori schools—eliminating grades, combining ages, using a lot of group work, and so on. One could take the view that over the years, conventional schooling has gradually been discovering and incorporating many of the principles that Dr. Montessori discovered in the first half of the 20th century. However, although schooling is changing, those changes are often relatively superficial. A professor of education might develop a new reading or math program that is then adopted with great fanfare by a few school systems, but the curricular change is minute relative to the entire curriculum, and the Lockean model of the child and the factory structure of the school environment still underlie most of the child’s school day and year. “Adding new ‘techniques’ to the classroom does not lead to the developmental of a coherent philosophy. For example, adding the technique of having children work in ‘co-operative learning’ teams is quite different than a system in which collaboration is inherent in the structure” (Rogoff, Turkanis, & Bartlett, 2001, p. 13). Although small changes are made reflecting newer research on how children learn, particularly in good neighborhood elementary schools, most of the time, in most U.S. schools, conventional structures predominate (Hiebert, 1999; McCaslin et al., 2006; NICHD, 2005; Stigler, Gallimore, & Hiebert, 2000), and observers rate most classes to be low in quality (Weiss, Pasley, Smith, Banilower, & Heck, 2003). Superficial insertions of research-supported methods do not penetrate the underlying models on which are schools are based. Deeper change, implementing more realistic models of the child and the school, is necessary to improve schooling. How can we know what those new models should be? As in medicine, where there have been increasing calls for using research results to inform patient treatments, education reform must more thoroughly and deeply implement what the evidence indicates will work best. This has been advocated repeatedly over the years, even by Thorndike. Certainly more and more researchers, educators, and policy makers are heeding the call to take an evidence-based stance on education. Yet the changes made thus far in response to these calls have not managed to address to the fundamental problems of the poor models. The time has come for rethinking education, making it evidence based from the ground up, beginning with the child and the conditions under which children thrive. Considered en masse, the evidence from psychological research suggests truly radical change is needed to provide children with a form of schooling that will optimize their social and cognitive development. A better form of schooling will change the Lockean model of the child and the factory structure on which our schools are built into something radically different and much better suited to how children actually learn.

Evidence-based medicine (EBM) seeks to integrate the best research evidence with clinical judgment and the patient’s values and preferences, while keeping in mind safety, effectiveness, and the cost of medical procedures.

Based on my research, the most significant dietary factor causing both pain and inflammation in the body are the consumption of polyunsaturated fatty acids (PUFA).  In my book Cancer: The Metabolic Disease Unravelled, I present a mountain of evidence revealing the following negative health consequences of PUFA: - It directly inhibits the cytochrome c oxidase enzyme - It inhibits the immune system by shrinking the thymus gland and by directly killing white blood cells - It lowers oxygen use by cells - It inhibits thyroid function in at least five ways

Goddess-centered awareness demonstrated the archetypal Divine Feminine awareness that generates and knows the rhythms and mysteries of life, death and rebirth. The Goddess knows what it is to create forms and life within herself, to sustain and nurture, to realize the potential in the seed, in new life and to bring it forth, to nurture it with the milk of her own body. The Goddess ' ways were reflected everywhere in nature, and humanity lived reverently for Her and sought to live in harmony with the wisdom she revealed. Society has been based on cooperation for thousands of years, and is neither matriarchal nor patriarchal. There were no fortifications or battle evidences for thousands of years. In the course of time, though, a new form of consciousness started to develop in what Eisler called the dominator mode. The dominator style has been synonymous with patriarchal forms of religion and Divine approaches that continue to exist to this day. The dominator mode also coincides with a shift in the culture of man where fortifications, battles, and wars developed between groups. That is what Eisler points to in her book title. She writes of the difference between the blade and the chalice. The chalice is a symbol of the Divine Feminine, the consciousness that holds and contains, that nurtures, that actualizes, vs. the blade that cuts and severs, differentiates, penetrates, and dominates. From my perspective, both are part of the full expression of Consciousness and forms that Shakti creates to express the full spectrum of Consciousness itself. The pendulum has swung to an extreme and is now moving back to a center that integrates the two consciousness modes.

Show me a study where a majority of subjects succeeded at the amount of weight loss you are suggesting. Do thin people get this health problem? What do you recommend for them? Please provide me with evidence based medicine and the opportunity for informed consent

When Redelmeier entered medical school in 1980, for instance, the conventional wisdom held that if a heart attack victim suffered from some subsequent arrhythmia, you gave him drugs to suppress it. By the end of Redelmeier’s medical training, seven years later, researchers had shown that heart attack patients whose arrhythmia was suppressed died more often than the ones whose condition went untreated. No one explained why doctors, for years, had opted for a treatment that systematically killed patients—though proponents of evidence-based medicine were beginning to look to the work of Kahneman and Tversky for possible explanations.

I was amazed at how expensive economists thought doctors were. They instituted many economic maneuvers—de-skilling medicine onto nurses and physician assistants; computerizing medical decision-making; substituting algorithms for thinking—because they assumed that doctors were such expensive commodities. And yet doctors were not expensive, at least, not the doctors I knew. We cost no more than the nurses, the middle managers, and the information technicians, alas. Adding up all the time I spent with Mrs. Muller, the cost of her accurate diagnosis was about the same as one MRI scan, wholesale. Economists did the same thing with the other remedies of premodern medicine—good food, quiet surroundings, and the little things—treating them as expensive luxuries and cutting them out of their calculations. At Laguna Honda, for instance, while most patients were on fifteen or even twenty daily medications, many of which they didn’t need, the budget for a patient’s daily meals had been pared down to seven dollars, which could supply only the basics. I began to wonder: Had economists ever applied their standard of evidence-based medicine to their own economic assumptions? Under what conditions, with which patients and which diseases was it cost-effective to trade good food, clean surroundings, and doctor time for medications, tests, and procedures? Especially ones that patients didn’t need? Although Mrs. Muller was an impressive example of Laguna Honda’s Slow Medicine, she wasn’t the only one. Almost every patient I admitted had incorrect or outmoded diagnoses and was taking medications for them, too. Medications that required regular blood tests; caused side effects that necessitated still more medications; and put the patient at risk for adverse reactions. Typically my patients came in taking fifteen to twenty-five medications, of which they ended up needing, usually, only six or seven. And medications, even the cheapest, were expensive. Adding in the cost of side effects, lab tests, adverse reactions, and the time pharmacists, doctors, and nurses needed to prepare, order, and administer them, each medication cost something like six or seven dollars a day. So Laguna Honda’s Slow Medicine, to the extent that it led to discontinuing ten or twelve unnecessary medications, was more efficient than efficient health care by at least seventy dollars per day. I

Skeptical Empiricism and the a-Platonic School The Platonic Approach Interested in what lies outside the Platonic fold Focuses on the inside of the Platonic fold Respect for those who have the guts to say “I don’t know” “You keep criticizing these models. These models are all we have.” Fat Tony Dr. John Thinks of Black Swans as a dominant source of randomness Thinks of ordinary fluctuations as a dominant source of randomness, with jumps as an afterthought Bottom-up Top-down Would ordinarily not wear suits (except to funerals) Wears dark suits, white shirts; speaks in a boring tone Prefers to be broadly right Precisely wrong Minimal theory, considers theorizing as a disease to resist Everything needs to fit some grand, general socioeconomic model and “the rigor of economic theory;” frowns on the “descriptive” Does not believe that we can easily compute probabilities Built their entire apparatus on the assumptions that we can compute probabilities Model: Sextus Empiricus and the school of evidence-based, minimum-theory empirical medicine Model: Laplacian mechanics, the world and the economy like a clock Develops intuitions from practice, goes from observations to books Relies on scientific papers, goes from books to practice Not inspired by any science, uses messy mathematics and computational methods Inspired by physics, relies on abstract mathematics Ideas based on skepticism, on the unread books in the library Ideas based on beliefs, on what they think they know Assumes Extremistan as a starting point Assumes Mediocristan as a starting point Sophisticated craft Poor science Seeks to be approximately right across a broad set of eventualities Seeks to be perfectly right in a narrow model, under precise assumptions

It’s more than possible that the world’s first mixed drinks were created in order to mask the bad flavors of the base ingredient. Alcoholic potions of our dim and distant past were far inferior to the technologically clean products we enjoy today. Archeological evidence shows that the ancient Egyptians used dates and other fruits to flavor their beer, and that Wassail, a spiced drink originally made with a base of hard cider, dates back to pagan England—it was served to celebrate a bountiful apple harvest. We also know that the Romans drank wine mixed with honey and/or herbs and spices. The practice could have arisen from the inferior quality of the wine, but it probably also had roots in the medicinal, restorative, or digestive qualities attributed to the various ingredients.

Like Galileo’s colleagues, the “Lockdown Left” has abandoned the discipline of evidence-based medicine. Instead of scientific citation, they rely on appeals to often undeserving authorities who have manufactured “scientific consensus” by cherry-picking data to support a predetermined policy. Sanctimonious bromides to “follow the science,” “trust the experts,” most often mean blind dogmatic trust in the official—and often whimsical—pronouncements of amoral pharmaceutical companies and their venal government vassals at captive agencies like CDC, FDA, NIH, and WHO.

When possible, quality is founded on evidence-based medicine that not only includes clinical data, but also economic and patient-centered outcomes.

Really, who doesn’t enjoy a massage? It feels really good, but despite all the love that athletes feel toward having their muscles rubbed and pressed, “There are very few evidence-based benefits for massage,” says Paul Ingraham, a massage therapist, former editor at ScienceBasedMedicine.org, and publisher of PainScience.com.

The art of medicine is being crowded out by the science of medicine—and its emphasis on evidence-based procedures, well-meaning protocols, and advances in Big-Health-Data-churning information technology. And it’s being squeezed out by the business of medicine—and its focus on time-consuming but questionable quality metrics, endless billing procedures, and an adherence to process that doesn’t necessarily put patients first. Put another way, the science and business of medicine have combined with a superficial focus on things like hospital gowns to essentially act like a Quentin Tarantino character going “medieval” on the art of medicine. But perhaps I understate.

I’ve argued that the good data that effective metrics provide are essential to advancing the science at the heart of evidence-based medicine. But I’ve also argued that not all metrics or standards are created equal, and we should not equate metric-tracking with trust-building, because to do so misses a crucial point: What looks good on paper and what drives the best outcomes in practice can be two very different things. Too often, what looks good on paper is what is possible to measure, not necessarily what is actually the best approach to caring for patients. And when we consider the costs of abiding by and tracking and reporting all of these metrics—the four hours of physician time, the eight hours of care team time, the $8 billion we spend as a nation every year—it’s pretty clear that we’re interfering with those best, relationship-building approaches. Instead of spending so much more of our national time, resources, and attention in medicine on creating artificial metrics designed to incentivize good physician and provider behavior while unwittingly reinforcing bad behavior, let’s give the art of medicine the room it needs to build trusting relationships in the way that the best doctors and medical practices have always done so: honestly, naturally, compassionately, and with the best outcomes for the patient squarely in mind.

In the age of evidence-based medicine, it is becoming strange to refer to daily clinical lessons. However, I find it useful to summarize what I learned from decades of practice. We need this perspective because the results of the current randomized controlled trials are of limited use among those who have acquired a good understanding of birth physiology. In these trials, conducted in large conventional departments of obstetrics, the physiological processes are highly disturbed, both in the study groups and in the control groups (Prendiville et al. 1988; Rogers et al. 1998).

I am not advocating relying solely on the mind to heal us; but denying its role in medicine surely isn’t the answer either. My hope, then, is that this book might help to overcome some of the prejudice against mind–body approaches, and to raise awareness that taking account of the mind in health is actually a more scientific and evidence-based approach than relying ever more heavily on physical interventions and drugs.