I agree strongly that classic EBM [Evidence Based Medicine] approaches can be very powerful in changing practice, where there are good, appropriately applied trials of interventions, that are clearly generalisible to the local population: magnesium sulphate for pre-eclampsia, for example. We have certainly used RCT [Randomised Controlled Trial] evidence to argue for change in the UK, and it is a powerful tool.
Evaluating the impact of information
- coming from a medicines of species to organs and experimenting with bodies around 1800 to EBM today, is learns that biomedicine is as much a cultural construct born out of the body/mind dichotomoy as any other (traditional) sector in a medical system.
My inclination is to attribute the current rigidity in approach in some (but by no means all) of the evidence based medicine community to an over-reliance on linear thinking, and an under appreciation of the role of complexity in human relations, thinking, knowledge, and understanding. However, I do think that the world is turning on this. New insights into knowledge capture and use, such as those expressed in narrative based medicine, and in realist review techniques, are beginning to inject a more complexity-aware consciousness into health care, I believe.
Health information, as almost any other information system, has its cycle or more precisely its spiral. This cycle/spiral starts with knowledge generation, then synthesis, dissemination, utilization, and finally evaluation of how the knowledge really helped acheiving what we aim - i.e. improve the health of our people. If we do not look at health information in such approach, I would claim that we're wasting important resources by focusing on a single component of the cycle.
In November 2008 the HIFA2015 steering group sent a message to the HIFA2015 email forum, asking for feedback from members. This feedback was presented to the British Medical Association in December, and was almost certainly an important factor in their decision to continue their financial support in 2009. On behalf of the steering group, I would like to thank all those who provided feedback. Some of you also kindly gave
permission for your comments to be shared publicly, and examples are now available on the HIFA2015 website at:
Your story reminds me of one told by a Harvard scholar doing his internship at the Mayo Clinic - famous for its patient record system. Being overworked, as many interns were, he took home with him a series of case notes to be written up after an afternoon in outpatients. While sitting at his desk overlooking a wintery park his mind wandered and he wrote up the case of a tree he was looking at. He recorded the name as Mr Elm Tree, and his address as No.3 The Avenue, Parkside.
The authors thought that there was no possibility of anyone taking the made-up condition of cello scrotum seriously because the cello does not get anywhere near a (male) player's scrotum. The body of the instrument is held just between the knees. The scrotum is at the apex of an isosceles triangle with the cello as the base and the player's thighs as the sides. To squash the apex down on the base would be a feat. In the authors' defence, they could be confident that no cello player would ever present to a doctor and say, "Doctor, it's my scrotum.
I like to echo Joseph Ana's sentiment that the story on cello scrotum is truly amazing! If the analogy fits, this reminded me of the practice of counterfeit medicines and other medical products. In the case of counterfeits, one deliberately produces a fake product; while in the case of the cello scrotum the authors faked a story for publication. Luckily the article does not seem to have caused any harm, unlike counterfeit
Gullibility may involve harmless spoofs, as here, but
it is also a major factor in the deliberate spreading of health
misinformation, and it is widely exploited by pharmaceutical companies,politicians and others with negative consequences on health and health care.