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Bibliography for my Talk at TAM 7: Why Evidence-Based Medicine is not yet Science-Based Medicine

As promised at the meeting. Let me know by comment if you think I left anything out.

 Intro to EBM.

Examples of prior knowledge having been insufficient to determine safety and efficacy.

  • Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo — the Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324:781-788. [Abstract]
  • Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial. Writing Group for the Women’s Health Initiative Investigators. JAMA. 2002;288(3):321-333. Available at: http://jama.ama-assn.org/cgi/content/full/288/3/321

Reasonable Cochrane Review (abstract).

Misleading Cochrane Reviews—due to failure to acknowledge the necessary role of prior knowledge (abstracts).

Laetrile; Ernst’s curious view of prior knowledge.

Misleading reviews from Natural Standard and Harvard Medical School.

Homeopathy: the Evidence.

Prior Probability and Bayes Theorem.

Misleading Trials.

Misleading Meta-analysis and systematic review.

Posted in: Science and Medicine

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10 thoughts on “Bibliography for my Talk at TAM 7: Why Evidence-Based Medicine is not yet Science-Based Medicine

  1. art malernee dvm says:

    Why Evidence-Based Medicine is not yet Science-Based Medicine>>>

    Has Sackett DL written about this subject?
    art malernee dvm

  2. Has Sackett DL written about this subject?

    Only what is cited above, as far as I know.

    KA

  3. daijiyobu says:

    Lots for me to ruminate. Was a great presentation. Glad to have finally met in person.

    [My impression of tweeting].

    -r.c.

  4. mckenzievmd says:

    While I’m learnig a lot (and seeing plenty of woo) at the Amer. Vet. Med. Assoc meeting, it sounds like I’m missing a lot of good stuff at TAM! Is there going to be anything like a proceedings for those of us who couldn’t make it?
    Thanks!

    SkeptVet
    http://skeptvet.com

  5. MichaelHartwell says:

    I don’t know a better place to share this Science-Based Medicine panel shot, so I’m putting it here.

    http://picasaweb.google.com/MichaelHartwell/TAM7#5357773764808003074

  6. Scott says:

    Really enjoyed the presentation. With respect to natural products, I find the Natural Medicines Comprehensive Database ( http://www.naturaldatabase.com ) is far more rigorous than the Natural Standard. You have to pay, but it’s well worth the cost for any health professional, especially those that respond to a lot of questions about natural products. It’s about the only tertiary source of information that I’ve been satisfied with.

  7. art malernee dvm says:

    Has Sackett DL written about this subject?

    Only what is cited above, as far as I know.

    KA>>>>

    I have read the hyperlink posted written by Sackett DL years ago in the BMJ when it was free to read. Now when I click on the BMJ link provided the BMJ wants me to pay money to read the entire article. I think “Coal Faced” family doctors trying to incorporate unfiltered data into private practice need a conference on how to make a living incorporating the data into private practice. Sackett drove a broken down piece of crap car in the old days when the BMJ article was free to read by the general public. Is science based medicine more profitable for a general practitioner than evidence based medicine? I suspect the word “Science” rather than “Evidence” will lead to more arguments about religion but am willing to live with that if you promise not to start charging for the articles on the sciencebased medicine website.
    art malernee dvm

  8. LindaRosaRN says:

    art malernee dvm wrote: …I suspect the word “Science” rather than “Evidence” will lead to more arguments about religion

    It’s my impression that the CAMsters have co-opted the terms “evidence” and “evidence-based medicine,” but with them having an entirely different standard for what constitutes “evidence.” It that’s the case, I’m all for taking back these terms.

  9. art malernee dvm says:

    I have a collection of Sackett DL (so called father of evidence based medicine) internet post from free internet groups like this one from years back before the science vs evidence debate was ,as far as i know, an issue. Maybe a similar study(see below) showing how much “clincial care” is “science based” would help people see the difference between evidence based and science based medicine as it applys to clincal practice. If there is a real difference between the two I would expect the data could show a difference. If the data is the same we might be measuring the same thing but just trying to practice “the art of medicine”.
    see
    Date: Tue, 5 May 1998 16:32:33 +0100 (GMT Daylight Time)
    From: Dave Sackett
    To: ‘EBH Discussion Group’
    Subject: Re: FW: Request for quote on how much clinical care is evidence-based

    1. the “20-25% of medical decisions are evidence-based” comes from a
    series of conjectures, many of them humorous, starting back in the 70′s.
    for example, in an exchange between two giants of epidemiology, kerr white
    (who related the incident to iain chalmers) and archie cochrane (after
    whom we named the collaboration) in wellington, nz, kerr had just
    suggested that “only about 15-20% of physicians’ interventions were
    supported by objective evidence that they did more good than harm” when
    archie interrupted him with: “kerr, you’re a damned liar! you know it
    isn’t more than 10%”.

    2. shortly thereafter [1978], the US Congress’s office of technology
    assessment reported that “only 10% to 20% of all procedures currently used
    in medical practice have been shown to be efficacious by controlled trial”
    and repeated the charge in 1983.

    3. these gloomy figures were more recently repeated on this side of the
    atlantic by richard smith (BMJ editor and a star supporter of ebm) as
    “where is the wisdom…the poverty of medical evidence” [bmj
    1991;303:798-9] and “the ethics of ignorance” [j med ethics
    1992;18:117-8].

    4. when i moved to oxford and started working on the general medicine
    wards here, these “armchair” pronouncements were raised by one of the
    bright young house officers (jon ellis) and we decided to test them. since
    we treat patients, not manoeuvers, we decided to determine the proportion
    of patients whose most important intervention for their most important
    diagnosis were based on systematic reviews/RCTs, on convincing
    non-experimental evidence (don’t need an RCT to tell you that it’s good to
    shock a VF-arrest), or without convincing evidence. our study was
    followed by a series of others of about the same design (consensus on the
    primary diagnosis, consensus on the primary intervention, tracking the
    intervention into the evidence, and asking one or more outsiders to
    independently review our interventions and their linkages to the
    evidence). we found that a service that ran like ours and worked hard to
    find the best evidence to guide its interventions could treat 53% of its
    patients on the basis of SRs and RCTs, another 29% on the basis of
    convincing non-experimental evidence, and just 19% on the basis of
    guessing and hope [lancet 1995;346:407-10].

    5. this sort of study has now been replicated (with similar results) in
    two other e-b oriented internal medicine in-patient groups, both here and
    in Canada.

    6. in e-b psychiatric services, both in-patient (67% of admissions treated
    on the basis of SRs and RCTs at the oxford centre for e-b psychiatry)
    [qual health care 1996;5:215-7] and out-patient psychiatry [poster and
    abstract at a psych meeting] documented results as good or better as
    those in medicine.

    7. similar results (more self-evident precedents than SRs/RCTs) have been
    reported to me (?in press) by two different in-patient services comprising
    the centre for e-b surgery [liverpool and manchester].

    8. dr gill and his colleagues reported on the interventions they applied
    in a consecutive series of consultations in their general practice in
    Leeds and found 31% based on RCTs and 51% based on convincing
    non-experimental evidence [bmj 1996;312:819-21]. none of their critics
    have backed up their critiques by doing their own studies, and i know of
    no others in primary care (maybe other list members can help us all here).

    9. a group of e-b paediatricians have finished a study (i don’t want to
    spill their beans) looking at it with manoeuvres as the denominators.
    suffice it to say that for Rx things are pretty much in line with the
    other audits.

    10. finally, a growing number of “outcomes research” studies are
    documenting better (and worse) outcomes for patients when their care is
    (and isn’t) evidence-based:

    a. where e-b docs use more ASA following MI’s, deaths are reduced
    by >20% [Circulation 1995;92:2841-7].

    b. where docs fail to use e-b indications for carotid surgery,
    peri-op stroke and death are many times higher than would have occurred if
    the patients had been left along [stroke 1997;28:891-8].

    c. where e-b docs use more warfarin and stroke unit referrals,
    mortality declines by >20% [stroke 1996;27:1937-43].

    hope that this helps.

    cheers
    dls
    Prof David L. Sackett Director, Centre for Evidence-Based Medicine
    ————————
    Art Malernee dvm

  10. Dr. Malernee et al,

    You may also want to look at a paper by one of our own bloggers (and a DVM), Dave Ramey:

    The Evidence for Evidence-Based Medicine

    It shows far better adherence to EBM principles than is usually claimed, even without including pre-clinical evidence (which was the main point of my talk at TAM 7).

    KA

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