Re: Episiotomy question --> EMB
From: art fougner, md (evsono@pipeline.com)
Mon Feb 18 13:46:03 2008
I've always defined metanalysis as the statistical process involved in
making a silk purse from a sow's ear.
Art
At Mon, 18 Feb 2008, R. Daniel Braun wrote:
>
>Not to mention when the evidence based medicine is based on flawed evidence.
>
>Dan
>
>On Feb 18, 2008 11:29 AM, < EMB">DoctorJoe@aol.com> wrote:
>
>> In a message dated 2/18/08 2:59:27 AM, AllanHo@aol.com writes:
>>
>> I don't know why you are telling me that - it is obvious that evidence
>> based medicine is preferable. In the absence of evidence, you can only go by
>> people's experience. There are so many variables when it comes to shoulder
>> dystocia. Every case is different. I am not sure what you are trying to
>> get at.
>>
>> Pet peeve of mine.
>>
>> We all "agree" that medicine based on evidence is best. I don't know
>> anyone who would (at least overtly) disagree with that. Apparently, that's
>> what "modern" medicine is becoming based upon more and more. That's one
>> thing.
>>
>> The problem is two-fold.
>>
>> 1) If there is NO evidence based medicine on a particular topic, then that
>> means you MUST use "eminence based" medicine, as el terms it. You have
>> nothing else to go on. However, what some people would argue (often when
>> they want to attack another doctor for some reason -- usually money) is that
>> if there is no evidence to support some practice, then it means the practice
>> must be wrong. This is backwards logic. Obviously, if there is evidence
>> based medicine to contradict the practice, that's one thing. But in the face
>> of NO EXISTING evidence based strategy, then you should only be required to
>> articulate some plausible scientific argument, be it basic science,
>> professorial opinion, or whatever.
>>
>> To repeat: It is wrong to censure someone for not having evidence based
>> support for their practice IF NONE EXISTS.
>>
>> 2) Secondly, if evidence based data exists to support some medical
>> practice, that does not (usually) make that practice appropriate for ALL
>> PATIENTS. If a practitioner treating a patient determines that the patient's
>> parameters do not fall within the evidence based window, she should be free
>> to vary the treatment as appropriate for that patient. There has to be room
>> for clinical opinion, otherwise we can simply let robots make the decisions
>> and have chimpanzees treat the patients.
>>
>> This is my complaint that protocols and pathways tend to mediocritize
>> medicine, rather than elevating the standard (as they are apparently meant
>> to do).
>>
>> "That is not logical, Captain" -- Spock
>>
>> Joe P.
>>
>--
>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science is BLIND"
> Einstein 1941
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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