"Evidence-based medicine" can be blind

Swimangel, you know I agree with you 100% on this!

Two things immediately come to mind regarding the limits of "evidence-based medicine":

1) Individuals are not groups -- just because findings apply to "94%" (or 78%, or whatever) of a group, does not mean they apply to everyone.  And if you are one of the "6%" or "22%" or even 1 out of a hundred or 1 out of a million -- the fact that you are in the minority does not render your situation "nonexistent."  Looked at another way, if there's "only" a 1% possibility of, say, a life-threatening reaction to a drug -- if you get that reaction, YOUR probability is 100% for you.

2) The other thing is what you said about "no evidence."  I have to thank Otter for sending me an article that repeated this axiom for medical/scientific researchers: A lack of proof of effectiveness is not the same thing as PROOF OF LACK OF EFFECTIVNESS.

Sounds like you need a new gyno.  It also sounds like it's easier (less hassle) for him to rely on EBM instead of treating the individual patient. 

I had a vaginal hysterectomy before I had cancer.  No abdominal surgery was necessary for the procedure.  I'm glad my uterus is gone.  One less thing to worry about.  Down the road, I had my ovaries removed due to an 8 cm tortion cyst, which turned out to be a huge invasive abdominal procedure. 

While I realize you're discussing EBM on this thread, it really sounds like your doctor has to go.  My docs evaluate the whole .. EBM, the patient, and what is best for the patient specifically.  My PCP once told me she practices medicine .. that it is part science, part art and part medicine. 

hugs,

Bren

Evidence-based medicine is indeed more of the science than the art. Stats are fine--for others.

But there have been GOOD things that have come from more emphasis on EBM--like less unneeded treatment with antibiotics, for that "just in case" infection that is either viral or will clear on its own. For treating asthma more with steroid inhalers initially, then just albuterol. For waiting a few weeks on getting an MRI for a sprained knee (in most people).

But I agree, swimangel, any doc who comes in spouting EBM as a reason not to have a dialog with me about what I know about my body, needs no longer to be my doctor. Anyone who is so rigid as to go ONLY by the book should probably go into research, not work with individuals.

Anne

I was a Victum of EBM, and the quote:". Newly created regiments of specialist practitioners, unburdened by the skepticism that follows a broad medical education, are taught to follow the rules, follow the guidelines, and all will be well. "  says it all for me.

I had urinary retention post op--not uncommon.  The first year resident in neurosurgery, (read intern, graduated 4 months previous) was up in arms that I'd had a straight in and out cath the night before (requested my ME and showiing a residual of 600cc) and wrote orders that I was to never have one again.  Her reason: possible introduction of bacteria to infect the hardware in my back.--Again, first part of a good reason.  BUT, just what was I supposed to do with all the urine accumulating in my bladder?  She just would Not get past the "hospital acquired infection:" part of straight in and out catherizations.  She put the fear of God into the nurses who would not call a more senior resident or my doctor.  Argue, I did, but to no avail.  My bladder became the size of  a large grapefruit, documented on x-ray! that she ordered to eval. my hip pain, that no one ever examined--just x-rayed. 

She refused to listen to any reasoning about ruptured bladder, retrograde urine into th kidineys, etc, etc.  Even my surgeon's nurse was at a loss of what to do???  She ordered a urology consult.  LOL  I finally peed a little at a time into a towel---took me over  6 hours to get relief---and then the urology consult arrived!!!!  Agreed with my dx and said that the first yr. "will have to learn".  Meantime, I learned what a level 9 on the pain scale means.

Cookbook medicine (EBM) has been discussed and demeaned by clinical practioners for decades (to all the researchers out there!).  stats are great, and can be made to say anything.  GUIDELINES are a much better way to practice medicine.  And if all else fails, examine/and listen to  the damn patient.  Mayo's and some bunch in the northwest ???  are going on EBM, and all are very happy to be on a salary and work 9-5.  Oh, and to be writing papers and collecting stats. 

Personally, I want my doc to understand that the body is inter-related---knee bone connected to the thigh bone kinda thing and to know more about the body than just his/her specialty.  That's why a neurosurgeon got a picture of my hip but didn't examine me ---wouldn't have known how to examine a hip number one, and number two wouldn't know to diagnose bursitis, let alone how treat it.

I feel for you young folks, you (and my kids) have to live with the new medical treatment and medical educations, and cost containment-- fortunately, I'm old enough that I won't be around so much longer to have to know the difference between a doc who treats people and one who practices cook book medicine.

As ER charge in a university hospital, staffed with Interns (not first year residents) who spent a year rotating thru all specialties, I was one of those nurses who didn't look forward to July 1.  Did you know that the death rate rose over July 4 and Labor Day weekends?  Every year!  Hmmmm.

  Most fun was when we'd have a code and the 'tern would demand I call the "harvey team" (cardiac team) and I would calmly whisper in his ear---Doctor, we ARE the harvey team!  At least I didn't ask if he wanted fries with that.   LOL

At least those guys/gals recognized a human body---not just the bones, or nerves or stomach, or whatever. 

As mentioned before, even if you don't have a medical family member---have family with you at all times.  Yes, they'll get tired, but it will save you a great deal of misery.  Unfortunately, I'm married to a surgeon and docs don't know that help is needed in the patient's room----they are just accustomed to writing orders and leaving, to return to have "it" done.  My dh, bless him, only "got it" when he  waited 10 hours to talk with the middle resident to request my dressing be changed first day post op.  When said resident finally arrived at 11 pm, he declined to change the dressing because my surgeon didn't want any of his dressings changed in the hospital (sound familiar: hospital acquired infection).  Of course, he didn't observe the dressing which was saturated and hanging off my back.  but he did agree to call my dh at the motel and then again refused to change it.  He Did agree to look at it and if he didn't agree it needed changing, my dh would talk with my surgeon in the morning.  Of course, he changed the damn dressing.

What all this says is one Must become one's own advocate, and if at all possible, have friends or family in the hospital with you all the time.  As I said, I was the victum of the worst nursing and medical care I've ever seen.  I truly never dreamed it could get that bad.  And I'm one who stands up for herself and actually knows why something should or shouldn't be done.  God help all the folks who are at the mercy of those hospital staff who know so little.

And do you remember why people didn't want to GO to hospitals 75 years ago?  Because they were dirty, you could catch a worse disease, and poor people just went there to die.  People were cared for at home until the 40's  (penicillin) and it became the norm to be hospitalized for anything in the 50's and in the 60's you had to be in the hospital to get your insurance to cover anything.  We're comming full circle.!!

This is such an interesting discussion. It is such great advice to have someone with a loved one in the hospital, even if they are top notch. My SIL is a med tech and when her father had a blackout they took him to the ER where they told him all was fine. She insisted on a specific test to see if he had actually had a heart attack and they refused. Since she was also a patient advocate for the hospital, she knew who to go to. She got the test run, and sure enough it proved he had had a heart attack. Someone who did not know any of this would have been left in the dark. If my SIL had not done this, her father might have died from another one. Instead he got the care he needed.

There really does seem to be a lot of movement now in going back to some of the old ways of preventing disease, from the use of iodine and cod liver oil, like my grandmother use to promote to even bleeding to get the build up of iron out of our pipes. Modern medicine has accomplished a lot of miracles, but some of the old ways were just as successful and a heck of a lot cheaper.

Swimangel-have you looked into chlorine toxicity from swimming pools? Just wondering because I have been reading on my yahoo group about iodine deficiency and the toxicity of chlorines and bromines in pools and hot tubs.

Ann I am just reading a book on the topic. It is called Survival of the Fittest, byt Dr. Sharon Moalem. It is about the historic study of disease and one of the things he notes is that babies who were fed extra iron during the great plagues did not survive as well as those who did not. We think of all the bloodletting they use to do as so barbaric, but he explains why in some cases, people did recover because it bled out toxic amounts of iron. We know that excessive iron is linked to cancer too. So I am going to see if it is okay to give blood and see how it makes me feel. I heard you can do so after 2 years. We shall see. Like everything else, I feel like my own guinea pig but I figure there is so much evidence that a lot of the standard protocols are useless anyway, so I am happy to be looking outside the box, because I feel fantastic. It still burns me that some drug study can only prove to work say 50% of the time and it is considered okay to use because they have the money to do the study, whereas any alternative with the same stats is considered quackery because it is unproven, even though there are lots of testimonials from people who have tried them and lived. But because they were not part of some "study" no one believes them. It is all a big racket.

Wow swimangel, the book I noted talks about the link to northern european ancestry and the disease related to too much iron. You really should get this book. Also, have you looked into the connection to iodine deficiency? Iodine is one of the family of halides that include chlorine, bromine, and flouride, all which are in all kinds of foods besides pools and are toxic. Iodine naturally draws those toxins out of the body. Iodine also is stored in breast tissue,where it does the most good. When we are iodine deficient, we are suseptable to cancer. Since I have learned so much about iodine deficiencies, I can look back and see all kinds of signs that were affecting my health. If only I had know then . . . But the good news in, taking iodine has made a huge effect on my body. I felt energized immediately and it totally softened my breast tissue, got rid of lumps, and the hard knotty scars from my surgery and rads. I expect that my therm next month will really show a vast improvement, because my last one was still red. I think this stuff is the  secret to prevention. If you have not checked out the info at breastcancerchoices.org and our iodine thread, please do. Also there is a discussion yahoo group that is an offshoot of naturalthyroidchoices.org that I learn a lot from. They were just discussing the swimming pool issues.

Vivre--the link didn't work...so I googled and found www.naturalthyroidchoices.com.  Is that what you meant?  

I'm hypothyroid (I take meds) and I'm interested to read more about this.  When I was young, I was also a competitive swimmer at the local swim club.  Never gave chlorine a thought.

Now we use sea salt with iodine in the water for pasta...wonder if that helps too.

EDIT:  I just quickly visited the link that is posted.  My question is when the link is .com instead of .org isn't that a company based on profit?  I'm always skeptical of the "evidence" they post.

Hi Vivre, Probably I wasn't clear in my writing.  The link that I said didn't work was the www. link not iodine.  That link I agree is well known.  I've followed some of the threads here that discussed it and I've paid some attention to my iodine intake since my hypothyroid diagnosis in the early 90s.  Recently my husband read that iodine is lost when boiled in water (pasta for example) and it was suggested to add the salt at the same time to add the pasta instead of before to boil the water.  Sea salt is a standard here.

I was talking with my sister yesterday and we both agree that toxins are here to stay and so is the frustration to purge them from the body.  I use an entire lemon with the skin, with three cloves of garlic and some olive oil with water in a food processor....then drink it.  It is a cleanser for the liver and gall bladder.  But who knows what the ratio of toxin to cells might be....it can't hurt me though.  

About the .org .com....it's been a test of mine to pay attention to these because .org needs to pass accounting and organizational tests that a .com doesn't.  That small hurdle (albeit not prefect) helps to sort extraneous information out.  It's not that there aren't kernels of truth to be found anywhere...and I seek it out too because the timeline of new research can be long.  It's just that I prefer to seek to balance the information I find with info distilled by trusted and knowledgeable science.  I often find they converge if there is sound basis to the findings.  Many words and hope not to confuse.

Getting back to the thyroid meds....it's still the one size fits all problem...like using a shot gun to hit a smaller target.  My endocrinologist advised me that the numbers are used as a guide to the symptoms....and my symptoms were painful.  Taking the meds I feel better.  I did a lot of reading and found help in suppliments from women walked the path before me...recommended books, ets.  It all helped and If I could manage it any other way then the meds and consistent I'd do it.  I admit too that I have so little time to do this work.  But for those who do bravo!  and grazie!  I'll keep reading your results.  We had some lengthy conversations on these boards several years ago when we linked some of our symptoms.

Best wishes to all as always,

Marilyn