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Evidence Based Medicine - some critiques incl. one calling it a "Zombie Science"

Discussion in 'Other Health News and Research' started by Dolphin, Jan 7, 2012.

  1. Dolphin

    Dolphin Senior Member

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    Full free text at: http://charltonteaching.blogspot.com/2009/08/zombie-science-of-evidence-based.html

    ---------

    One might be able to find the full text of this if one searches around the site.
     
  2. Dolphin

    Dolphin Senior Member

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    I read the Charlton and Charles et al. papers yesterday.

    The Charlton paper is quite good in terms of showing how EBM might be maintained/grow. However, I found it didn't give many details about where the problems with EBM lie except that at an individual level, "average" results from RCTs might not be the best for any individual patient. It would be good if examples of the problems with this sort of thinking (treat the patients the same basically) were given.

    I had been slightly wary of the term Zombie Science before this as it seemed quite dramatic and perhaps over the top/would seem that way. But am more thinking now that it might be justified.

    Some quotes from the Charlton paper:

    I can see that with all the CBT studies that are churned out by Nijmegen for example. They keep coming up with ways to present the data as a success even though their own studies showed the patients' activity levels didn't increase over the control levels. It also happens to an extent in the UK with all the studies that are churned out there. And all the funding such researchers can get.

    I think this is interesting given how little discussion there can be about biological matters in the ME/CFS field. The Lancet PACE Trial, a substantial paper, doesn't mention biology at all.

    I think a reason/another reason why such a system likes nurses and generally "non doctors" is because they can't prescribe many drugs (and the oens they can are usually only fairly cheap ones) nor can they order tests generally. So cheaper, along with making it easier to estimate what the budgets will be.

    - I think this is particularly interesting. That, say, with the NICE guidelines, or when some other guidelines are being drawn up, some evidence for or against CBT/GET or the alternatives can be seen as acceptable or unacceptable (sufficient/insufficient or good quality/not good quality) as it suits them.
     
  3. Dolphin

    Dolphin Senior Member

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    I'm not sure if I have the time to post up all my notes on the Charles et al paper. It isn't a polemic like the Charlton piece.

    It shows how the EBM model has changed over the years. How many aspects of it are unclear.
    In particular, it's unclear how much weighting to give to the different aspects that make up the model.

    At the moment they are:
    - Clinical state, setting and circumstances
    - Patient preferences and actions
    - Research evidence
    - Health care resources
    - Clinical Expertise
    (the paper talks also about how some of these aren't always well-defined or the definition changes).

    I found it interesting that "Patient preferences and actions" (or "Patient preferences") are part of it - they don't seem to play a major role in say the UK, Belgian or Dutch (? - don't know as much about the Netherlands) models of care. And with the PACE Trial and other discussions, patient organisations are often criticised - even though they are often simply giving patient opinions.
     
  4. Valentijn

    Valentijn Activity Level: 3

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    Amersfoort, Netherlands
    In the Netherlands I had the choice of going to Nijmegen (hahahahahahaha) for CBT or to a real ME/CFS clinic in Lelystad. I also could have requested a referral to one of the other clinics, including one that's apparently just doing research and not much treatment in Amsterdam.
     
  5. Dolphin

    Dolphin Senior Member

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    Thanks, Valentijn, that's good to know. I have the odd bit of interesting research from the Netherlands e.g. by Vermeulen, but wasn't sure if they were available as part of the public system or not.
     

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