Evidence Based — Having Second Thoughts!

So this morning I taped my radio show for airing this Sunday. During each show, I provide a sharp patient tip — a tool or piece of information anyone can use to help them better navigate the dysfunctional system we call American healthcare.

This week’s tip is about making judgements about treatment options based on scientific evidence — you know — where real experiments on real people have proven one thing works — or doesn’t. Specifically I was addressing recent reports that zinc and echinacea supplements don’t really help relieve a cold. I took the stand that if you understand what the real scientific evidence says, then you won’t waste your money on those supplements, or many other remedies, that don’t really work.

But — I’m having second thoughts now. What I realize is that none of these studies (as near as I can tell) ever account for the very real ability for someone’s head to practically over rule their physiology. For example — one recent study says that chondroitin and glucosamene are ineffective in relieving pain for arthritis sufferers. Oh really? Then how do we account for all those people who say it really helps them? Who is judging their opinions? Do we think they really DO have pain, they just don’t realize it?

Secondly — it occurs to me that “evidence-based” never seems to account for individual differences. It reminds me of when I was a first-grade teacher. We would be told that a certain method of teaching (for reading and math in particular) was THE method — when, in fact — now we know that different people (children) learn in different ways.

So who’s to say that individual bodies won’t react to treatments differently? Actually — we DO know that! So — how do we now marry those two concepts that account for individuality?

For now, I’m going to think about it this way. Perhaps “evidence based” represents the majority. But anecdotal evidence by individuals who find relief must still be accounted for — and respected.

1 thought on “Evidence Based — Having Second Thoughts!”

  1. You raise some good questions. As a Registered Nurse and Medical Librarian, I also get confused about studies that tout new treatments or preventive supplements. It’s really hard to decipher the validity of those studies. Remember when saccharin was shown to be a big no-no because it caused cancer in rats? If the study was applied to humans, they had to drink 100 (or some such huge number) diet drinks a day to develop cancer.

    Medical students and residents take whole courses and attend Journal Clubs to learn how to determine the validity and applicability of studies to real situations, so it is understandable that healthcare consumers can get confused by them and should be cautioned to act on results of a study judiciously. You are right that studies often look at a particular population of people, so the results may not be applicable to the individual situation of a particular patient.

    I think a good thing for a patient advocate to do is to encourage patients to talk with their doctor before they make any changes or take any new supplements based on studies the have read and heard about.

    Ideally, they have doctors with whom they have developed a good partnership. Doctors who practice Evidence-Based Medicine (another thing patients should be encouraged to look for in a doctor) will work with them to make those decisions.

    The definition of EBM (David L. Sackett, Professor, NHS Research and Development Centre for Evidence-Based Medicine, Oxford) is: “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Basically it means that practitioners make treatment decisions based on a combination of 3 factors: 1) accepted guidelines developed from the best evidence, 2) their judgement based on clinical knowledge and experience, and 3) the INDIVIDUAL NEEDS AND PREFERENCES OF THE PATIENT.

    Lastly, people should take studies with a grain of salt and talk to a trusted, high quality practitioner before making any changes to their treatment or healthcare plan. If you question your doctor’s advice, time for a new doctor.

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Trisha Torrey
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