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Barrett -> The evidence for evidence-based medicine (June 9, 2001 11:12:00 AM)
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I came across an interesting article in the latest issue of “The Scientific Review of Alternative Medicine” yesterday that should be of interest to those who watch this part of the forum. It was entitled “The Evidence for Evidence-Based Medicine” by Robert Imrie and David Ramey, both veterinarians. They take issue with the long-held notion that standard medical practice is not commonly supported by the kind of evidence we would hope for. I presume that physical therapy would be lumped in here with the way in which physicians practice. The origin of this kind of thinking is carefully explained in the following passage from the article:
“In recent years the claim that only 20% or less of standard Western medicine is evidence-based has been repeated widely by health professionals and others. This assertion is perhaps most often made by proponents of unproven (“alternative” and “complementary”) therapies with the implication that, if true, it might somehow justify the integration of any number of unconventional modalities with a similar dearth of supporting scientific evidence into mainstream medical practice. It should be immediately noted that this line of reasoning is an example of the logical fallacy tu quoque (“you did it too”): One party cannot criticize another because both parties are guilty of the same “sin.” While this argument may be without merit, it is often made and widely held to be valid.
The original claim that “it has been estimated that only 10 to 20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trial” first appeared in print in a document published by the U.S. Congressional Office of Technology Assessment (OTA) in 1979 and was repeated in 1983. The claim stems from the comments of OTA advisory panel member and noted epidemiologist Kerr White. Dr. White based his informal “10 to 20%” estimate on a 1963 paper that reported on two surveys of the prescribing practices of 19 family doctors in a northern British town for 2 weeks (one conducted in December 1960, and another in March 1961). Interestingly, the paper was never intended to evaluate the science of medical practice; rather, its purpose was to look toward controlling prescribing costs in terms of standard (i.e., “generic”) versus “proprietary” drugs.”
Imrie and Ramey go on to detail more recently acquired surveys indicating that the practice of medicine can be justified by evidence in a large percentage of cases, which should make us wonder about all the complaints to the contrary. There is also within the article a discussion of “self evident interventions” i.e. ways of managing problems that make so much sense and are so distinctly necessary that they needn’t be “proven effective” in order to justify their use. Blood transfusions and antibiotics for bacterial infection fall into this category. Would various movement therapies for pain secondary to mechanical deformation make enough sense to be included here?
In any case, I was wondering if anyone else had a comment on the subject.
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