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Monday, August 27, 2012

Hilary Butler-Non-Evidence based medicine


Non-Evidence based medicine, Part one

Hilary Butler - Friday, September 03, 2010

A friend of mine, has not long got out of hospital with her fully breastfed baby. She didn’t actually “want” to be in there but the doctor noted a mild fever, and instantly got “fever phobia” and insisted she go to hospital. ESPECIALLY as the baby wasn’t vaccinated. The mother had been quite content with dealing with it herself, but her mother saw the baby and wet her knickers, insisting that the slightest fever needed to be look at by a doctor! To keep her mother happy, (big mistake) she went to the doctor. She didn’t realise that he too, had conditioned fever phobia. Once she got into hospital, things started to unravel.
Without even so much as a swab, H1N1 was pronounced, and then… pneumonia… with the instant rattle of heavy duty antibiotics. The mother folded her arms and said, “I don’t hear or see any signs of pneumonia?”, so the doctor ordered an X-ray, which came back… negative. “Oh, but we think you should do the antibiotics anyway, because it’s H1N1.”
“How do you know it’s H1N1? Where is the evidence for your assertion? Why don’t you test her for it to be sure” the mother intoned.
(Mistake number one: Questioning a diagnosis pulled out of the air on the basis that since H1N1 is “going around” everything must be H1N1.)
“Oh, we can’t do that. The test is expensive, will take a couple of days to come back, and anyway, if we do this right now, she’ll be fine before the results come back!!” the doctor chirped.
Out came the thermometer. “Ah, her temperature is 38.2 degrees. Well give her paracetamol.”
“No you won’t,” said the mother. “Fever is an appropriate response to any infection and shouldn’t be suppressed with drugs.”
( Mistake number two: Telling doctors facts from their own medical literature.)
By this time, the medical profession were getting more than antsy towards this mother. She went to the toilet, leaving her baby alone, and while she was there, the staff administered paracetamol – without her permission.
(Mistake number three: Assuming medical people will leave your baby alone while you back is turned)
She started to mentally lose the plot, but did some deep breathing and decided to cruise, and to say whatever it took to get out of there.
This involved a few lies, and jollying along the staff without compromising her stance. At the same time, when their backs were turned she used other “ways and means” and pretty soon the baby perked up, and the temperature reduced enough for the hospital to say that the bed was needed for someone else.
Once home we sorted it all out and the baby is fine.
This mother couldn’t get out of there fast enough, but you know what?
Her baby will be another unproven H1N1 case for the medical profession to add to it’s statistics which will become part of the “evidence” misinformation.
What worries me, is that not only do we have a medical profession who practice ANYTHING BUT evidence based medicine, but that doctors have also become “thought police”.
There is huge hypocrisy surrounding what the skeptics worshipfully call, “evidence-based medicine”.
For those unsure of what evidence based medicine is: “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
This of course, is sometimes a chicken and egg situation. 
To get evidence people have to experiment on people.  So sometimes "medical practice" is NOT based on any solid foundation of evidence because there is not yet evidence to refer to.
The medical profession is generally quite happy to experiment on people (witness the long list of off-label and unproven medical treatments used in neonatal intensive care units), so long as those ideas come from them - not the patient.

Non-Evidence based Medicine: Part Two

Hilary Butler - Friday, September 03, 2010
How much medicine is actually ‘evidence based?” Nineteen years go, in a British Medical article called “Where is the wisdom?” the opening paragraph contained this information:
“There are perhaps 30,000 biomedical journals in the world and they have grown steadily by 7 % a year…”
(Just think how many there are now!)
“… yet only about 15% of medical interventions are supported by solid scientific evidence… this is partly because only 1% of the articles in medical journals are scientifically sound… if it is true that ‘every defect is a treasure’ then we are sitting on King Solomon’s mine.”
The situation today is actually worse, because medical technology has exploded to the point where treatments used in ICU, like this famed ECMO treatment for flu patients, are not yet based on an “evidence base” because until they’ve been used on lots of adult patients (guinea pigs), the evidence base can’t be written up. Few patients know that ECMO is experimental.  Most think that all ICU treatment is solidly science based.
When an “evidence-based” review cast doubt over the use of albumin in emergency treatment, ICU experts got very upset. Ironically, their replies provided no evidence to support their dismissal of the review! Another articlerebutting the Cochrane review also glossed over the fact that they too were hung with their own inadequacies. The Cochrane team had to review 'garbage' for evidence, ... and therefore, concluded that the treatment was “garbage”. You know? Garbage in, garbage out. Whose fault is that?
The medical system has a love hate relationship with evidence based medicine. They love it, … when the evidence suits themselves, but hate it, when the evidence doesn’t suit their own beliefs. They will use treatments for which there is no evidence base, when it suits themselves, and dismiss other treatment modalities,.... when it suits them to do so.  They can see no hypocrisy in this.
People always assume that VACCINES are well proven using “evidence based” medicine. After all, people like Dr Paul Offit say that vaccines are the best tested of all medicine. (Which if true, is actually an indictment on all the rest of medicine.)  But this belief people and skeptics have, is reinforced by the medical policy makers, who go to Skeptic conferences and reinforce the dogma. Have the skeptics bothered to go and read the “evidence” for themselves?
I giggled when I read this medical article whine called, “Why is evidence based medicine so harsh on vaccines. An exploration of the method and it’s natural biases?” 
The article stated: “It is disappointing on the surface that two 20th century victories for modern medicine appear to have collided with the failure of evidence-based medicine to find support in the literature for cherished practices in vaccinology.”
This article came hard on the heels of yet another evidence based review finding the flu vaccine as useful as a pogo stick for a fish.  One of the authors is the editor of the medical journal ‘VACCINE’ and is so dyed in the wool, you can be sure that "evidence based medicine" will never get in the way of any vaccine!
And it’s funny how “evidence based medicine” has natural biases when it doesn’t suit the vaccinologists, who of course, couldn’t possible have their own “natural biases”!
Most people at ground zero in the medical profession have no idea how much of what they do to people is NOT evidence based, and neither do they realise that there is a huge closet of secrets about which they know nothing, and which is full to busting with skeletons just ready to tumble out if they open the door.
Most skeptics don’t realise that either.
When asked to jump to the defence of a cause, they don't ask why, they just ask, "How high?" And never stop to think about it.

Non-Evidence based Medicine: Part Three

Hilary Butler - Friday, September 03, 2010
Like many of my friends, there was once a time when I trusted the system; was ignorant about the actual lack of “evidence base”; and assumed that what I was told was right. Because of this naivety, I learned the hard way that the system can be wrong. Since then, I’ve done my best to keep myself out of this system, but when neded, I have never hesitated to confront the system  in order to get the best for my family or friends, and protect them from the worst. I’ve only been able to do that, with a backbone honed from years of research into all sorts of diagnostic scenarios, so that I know what is supposedly gold standard treatments, what evidence (or lack of) that’s based on, and the flaws.
Standing up for your family or your friends, comes with a price. The “black mark” for speaking up, has followed me into each next encounter more times than I care to count. Just like the elderly who speak about against elder abuse in rest-homes… if patients or friends in hospital speak out, the next time, depending on the team they get, may not be pretty.
But at the back of my mind are these questions: “What if some idiot drunk driver decided to make me into a broken pretzel? Who will be able to get for me, the best from the system and protect me from the worst of the system, other than God?"
My trust in the people within the medical system is that “rock bottom”. I see very few doctors prepared to stand against their colleagues, and be effective advocates for their patients. The system’s needs dictate doctors’ actions, which is grossly unfair.
It is an utter tragedy to have a state- run medical system founded on self protection, which treats with contempt, people who know and challenge medical practice, or ask for something which the system hypocritically considers isn’t “evidence based”!
The system tries to keep everyone right where they want them. Most of the time they succeed, because most people allow themselves to be walked over. New Zealand is a nation of sheep in more ways than one, so the system has never had to systemically confront the fact that they need to change how they view informed patients (and uninformed patients).
There is a serious shortage of conviction, backbone and activism in this country, and one day the results of this might be that we get UTTERLY screwed, because collectively, the public hears little (if anything) from medical people who know these facts, but don’t forcefully denounce them.
Those of us run over by the system, tend to clam up, and vote with our feet and never confront the system unless we have to. It’s time for us to stop saying, “Oh, but if I speak out, I or my child might be in the firing line the next time.” What if that next time is us? Who will be there for you?
The more people sit back, the happier the system is. It’s time for action.
One question is, “How can the system be changed?” But another more realistic question is, “If the system refuses to be changed, how can I guarantee that if I need serious help, I have people around me, prepared to support me, to get what I want?”
Seriously people, it's time that you find like minded people and work on collective supportive networks, of people with some backbone.  Some say, "Silence is golden".  Yeah, it is for the vested interests protecting their bank balances, but sometimes... silence is simply... yellow (cowardice)!
This morning someone told me they had just come back from doing errands, and were impressed by a bumper sticker on a four wheel drive vehichle which read:
"WHEN INJUSTICE BECOMES LAW - REBELLION BECOMES DUTY"
Maybe it's time for a rebellion.

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