alex3619
Senior Member
- Messages
- 13,810
- Location
- Logan, Queensland, Australia
Empirically based treatments and science based treatments are not synonymous, though related.
There are many facets of evidence based medicine. Most of it practiced today is more Evidence Based Medical Management. Its NOT science. Its managerial.
There is a growing conflict between Evidence Based Medicine and Evidence Based Medical Practice, or just Evidence Based Practice. Much of EBM is irrational when you use the rules of EBP. EBP is about applying reason and evidence to clinical decision making. EBM is largely, due to pervasive institutional influences, about how to manage or promote treatment choices, with a particular emphasis on economic factors, either directly or implicitly.
I do agree that its important to research obvious toxicology from supplements and drugs ... all of them. I do agree that the pattern of poor response to supplements or drugs could be a clue. I do agree that full genomic analysis is useful in many cases.
However there are other issues here. Even with training and resources not everything is always obvious. Science is a work in progress, and the information needed might not even be available yet. Cost can be a huge factor ... many of us could only do these things if they were free or very very cheap. Many of us have issues with interpreting the results .... and that is not just about intelligence, brainfog or lack of training. Its also that the science is not evolved enough yet. This kind of investigative approach to medicine is the future, but we are only just starting down that path. When we have Star Trek Medicine, and a doctor can just wave a technomagic wand at a patient and the device does the testing and the doc reads it on his computer screen .... that is when this becomes universally available to all patients.
Used responsibly most supplements and herbs are safe most of the time. Minerals are less so as the tolerance ranges are often small, and impacts on one mineral might affect tolerance to others.
Used excessively anything is dangerous .. even water or oxygen.
One of the issues we face is that ideal nutrient values need to be established empirically. RDAs are only for avoiding deficiency, and aimed at being 95% effective at doing so - which means that potentially 5% of patients (and there are confounds here) will not get enough at RDA levels.
RDAs are not about optimum nutrition. Optimum is probably over the RDA levels by quite a lot.
Drugs are a huge issue though. The body has mechanisms that can deal with nutrient imbalances within reasonable ranges, but this is not the case for drugs. We have not had millions of years to adapt to prozac, for example.
Drugs are indeed about risk/benefit ratios. So is vaccination, though the argument is slightly different there. Yet one of the driving forces behind EBM is that many drugs have been found, through later studies, to be harmful or fail, despite very good initial results. This applies even to dbRCTs.
EBM is great for well developed established areas in medical research. I think its a nonsense for cutting edge, muddled and under-researched areas of medicine. Its like saying its OK to come to a definitive decision with only X% of the knowledge needed, where X is largely unknown and might be 1% or 90%. This is fancy managerial guesswork, not science.
There are isolated cases of patients doing well with simple therapies. Several times this is just vitamin B1, or B12, and there are other examples. Yet such isolated cases tell us little about the mechanistic impact and how that relates to the broad majority of patients.
At the moment I am investigating the literature surrounding ACE inhibitors and bradykinin, largely due to something @MeSci wrote. I am beginning to question the whole notion of giving ACE inhibitors to anyone with CFS or ME. With no exceptions, every single worsening symptom I have had back to about 1998 coincides with the use of ACE inhibitors, and the symptoms are known side effects. Every single doc has missed this, and I have seen many, and indeed when in hospital and they switched me to Ramipril, and I had increased neuropathic problems, and asked the hospital pharmacist, they had no idea. There are even grounds for thinking ACE inhibitors can make OI worse. The test for me is simple: I will be investigating and eventually trialling alternative medications. If many of my symptoms go away then I have some confirmation. This already happened while I was in hospital on Ramipril, which was not my usual prescription. My symptoms changed.
I may say more later, this is getting too long and I need a break.
There are many facets of evidence based medicine. Most of it practiced today is more Evidence Based Medical Management. Its NOT science. Its managerial.
There is a growing conflict between Evidence Based Medicine and Evidence Based Medical Practice, or just Evidence Based Practice. Much of EBM is irrational when you use the rules of EBP. EBP is about applying reason and evidence to clinical decision making. EBM is largely, due to pervasive institutional influences, about how to manage or promote treatment choices, with a particular emphasis on economic factors, either directly or implicitly.
I do agree that its important to research obvious toxicology from supplements and drugs ... all of them. I do agree that the pattern of poor response to supplements or drugs could be a clue. I do agree that full genomic analysis is useful in many cases.
However there are other issues here. Even with training and resources not everything is always obvious. Science is a work in progress, and the information needed might not even be available yet. Cost can be a huge factor ... many of us could only do these things if they were free or very very cheap. Many of us have issues with interpreting the results .... and that is not just about intelligence, brainfog or lack of training. Its also that the science is not evolved enough yet. This kind of investigative approach to medicine is the future, but we are only just starting down that path. When we have Star Trek Medicine, and a doctor can just wave a technomagic wand at a patient and the device does the testing and the doc reads it on his computer screen .... that is when this becomes universally available to all patients.
Used responsibly most supplements and herbs are safe most of the time. Minerals are less so as the tolerance ranges are often small, and impacts on one mineral might affect tolerance to others.
Used excessively anything is dangerous .. even water or oxygen.
One of the issues we face is that ideal nutrient values need to be established empirically. RDAs are only for avoiding deficiency, and aimed at being 95% effective at doing so - which means that potentially 5% of patients (and there are confounds here) will not get enough at RDA levels.
RDAs are not about optimum nutrition. Optimum is probably over the RDA levels by quite a lot.
Drugs are a huge issue though. The body has mechanisms that can deal with nutrient imbalances within reasonable ranges, but this is not the case for drugs. We have not had millions of years to adapt to prozac, for example.
Drugs are indeed about risk/benefit ratios. So is vaccination, though the argument is slightly different there. Yet one of the driving forces behind EBM is that many drugs have been found, through later studies, to be harmful or fail, despite very good initial results. This applies even to dbRCTs.
EBM is great for well developed established areas in medical research. I think its a nonsense for cutting edge, muddled and under-researched areas of medicine. Its like saying its OK to come to a definitive decision with only X% of the knowledge needed, where X is largely unknown and might be 1% or 90%. This is fancy managerial guesswork, not science.
There are isolated cases of patients doing well with simple therapies. Several times this is just vitamin B1, or B12, and there are other examples. Yet such isolated cases tell us little about the mechanistic impact and how that relates to the broad majority of patients.
At the moment I am investigating the literature surrounding ACE inhibitors and bradykinin, largely due to something @MeSci wrote. I am beginning to question the whole notion of giving ACE inhibitors to anyone with CFS or ME. With no exceptions, every single worsening symptom I have had back to about 1998 coincides with the use of ACE inhibitors, and the symptoms are known side effects. Every single doc has missed this, and I have seen many, and indeed when in hospital and they switched me to Ramipril, and I had increased neuropathic problems, and asked the hospital pharmacist, they had no idea. There are even grounds for thinking ACE inhibitors can make OI worse. The test for me is simple: I will be investigating and eventually trialling alternative medications. If many of my symptoms go away then I have some confirmation. This already happened while I was in hospital on Ramipril, which was not my usual prescription. My symptoms changed.
I may say more later, this is getting too long and I need a break.
