Acupuncture appears to show results.

[Skeptic Ginger]

BillyJ is referring to this:
Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine

Does teaching and learning evidence-based medicine improve patient outcomes?

The proof of the pudding of evidence-based medicine lies in whether patients cared for in this fashion enjoy better health. This proof is no more achievable for the new paradigm than it is for the old, for no long-term randomized trials of traditional and evidence-based medical education are likely to be carried out. What we do have are a number of short-term studies which confirm that the skills of evidence-based medicine can be taught to medical students [35] and medical residents [36]. In addition, a study compared the graduates a medical school that operates under the new paradigm (McMaster) to graduates of a traditional school. A random sample of McMaster graduates who had chosen careers in family medicine were more knowledgeable with respect to current therapeutic guidelines in the treatment of hypertension than were the graduates of the traditional school [37] . These results suggest that the teaching of evidence-based medicine may help graduates stay up to date. Further evaluation of the evidence-based medicine approach is necessary.

Our advocating evidence-based medicine in the absence of definitive evidence of its superiority in improving patient outcomes may appear to be an internal contradiction. As has been pointed out, however, evidence-based medicine does not advocate a rejection of all innovations in the absence of definitive evidence.

I think BJ is misinterpreting what this says.

 

[Ivor the Engineer]

Thanks Prof.

What would be really cool is to combine an insulin dispenser with a blood glucose monitor and embed the device in the patient's abdomen.

http://www.jdrf.org/index.cfm?fuseaction=home.viewPage&page_id=4FE619DE-1321-C834-03EA38F133249485

 

[BillyJoe]

BillyJ is referring to this:
Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine
I think BJ is misinterpreting what this says.

I think you are misinterpreting what I am saying.

 

[BillyJoe]

Isn't that what we've been talking about?
What makes you think that isn't what's happening?

Well, okay, you did say that we have a badly skewed sample of clinical trials here on the forum. But that link you provided says it can be extremely difficult and time consuming to find, evaluate, and choose trials that are useful and goes to great lengths to show how to pick out methodological errors in trials and how to account for them. But the information in that link dates back to 2001, so maybe you are correct. Maybe things have improved since then.

 

[Skeptic Ginger]

I think you are misinterpreting what I am saying.

You are allowed to just take it back, you know.

 

[BillyJoe]

May I suggest that 'Evidence-Based Medicine ™' would have saved you some trouble?

 

[BillyJoe]

You are allowed to just take it back, you know.

Well, I have done my bit. I already said that I stated what I did "a little too compactly". But, in my defence, I was replying to Linda about her link and I assumed she would have understood my extract from that link in context. Alas...she's left me rudderless!

 

[fls]

Well, I have done my bit. I already said that I stated what I did "a little too compactly". But, in my defence, I was replying to Linda about her link and I assumed she would have understood my extract from that link in context. Alas...she's left me rudderless!

In light of new evidence, I take back what I said.

I understood. I thought that Skeptigirl and JJM misunderstood what you were referring to (which is why I suggested the change). Now I see that it is your intentions that were misunderstood. I feel for you, but it seems hopeless.

Linda

 

[fls]

Well I don't read JAMA too often since I have to get them from the library, but JAMA was the journal I had in mind because I had read that article from '98 I had linked to. But I see a fair amount of CAM when I'm browsing PubMed.

We were talking about incentives to performing good quality research. If professional advancement is tied to doing good research, as measured by factors such as number of times your research is cited and the impact factor of the journals in which your research is published, it punishes the average altmed researcher whose research does not meet quality standards for publication in higher impact journals (depending instead upon publication in altmed journals) regardless of how often other altmed researchers cite her/his results. On the other hand, it works to reward altmed researchers who perform good quality research as they will be able to publish in higher impact journals and may also be cited more frequently as they have less competition.

If professional advancement is tied only to the number of publications, then there is no real incentive for altmed researchers to perform good quality research, since there are plenty of outlets for their work.

Linda

 

[BillyJoe]

In light of new evidence, I take back what I said.

I understood. I thought that Skeptigirl and JJM misunderstood what you were referring to (which is why I suggested the change). Now I see that it is your intentions that were misunderstood. I feel for you, but it seems hopeless.

Linda

Tell me about it.
Maybe I should stop thinking out loud whilst I'm reading.

 

[Skeptic Ginger]

We were talking about incentives to performing good quality research. If professional advancement is tied to doing good research, as measured by factors such as number of times your research is cited and the impact factor of the journals in which your research is published, it punishes the average altmed researcher whose research does not meet quality standards for publication in higher impact journals (depending instead upon publication in altmed journals) regardless of how often other altmed researchers cite her/his results. On the other hand, it works to reward altmed researchers who perform good quality research as they will be able to publish in higher impact journals and may also be cited more frequently as they have less competition.

If professional advancement is tied only to the number of publications, then there is no real incentive for altmed researchers to perform good quality research, since there are plenty of outlets for their work.

Linda

It takes time for change and has to start somewhere. But I understand your point and think it is valid.

 

[Skeptic Ginger]

Well, I have done my bit. I already said that I stated what I did "a little too compactly". But, in my defence, I was replying to Linda about her link and I assumed she would have understood my extract from that link in context. Alas...she's left me rudderless!

I think "too compactly" is a stretch for:

....and a bit of irony:

There is no evidence that evidence based medicine improves patient outcomes.

But just for the record, I went back to see what you were talking about and then said so.

BillyJ is referring to this:
Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine

Does teaching and learning evidence-based medicine improve patient outcomes?

The proof of the pudding of evidence-based medicine lies in whether patients cared for in this fashion enjoy better health. This proof is no more achievable for the new paradigm than it is for the old, for no long-term randomized trials of traditional and evidence-based medical education are likely to be carried out. What we do have are a number of short-term studies which confirm that the skills of evidence-based medicine can be taught to medical students [35] and medical residents [36]. In addition, a study compared the graduates a medical school that operates under the new paradigm (McMaster) to graduates of a traditional school. A random sample of McMaster graduates who had chosen careers in family medicine were more knowledgeable with respect to current therapeutic guidelines in the treatment of hypertension than were the graduates of the traditional school [37] . These results suggest that the teaching of evidence-based medicine may help graduates stay up to date. Further evaluation of the evidence-based medicine approach is necessary.

Our advocating evidence-based medicine in the absence of definitive evidence of its superiority in improving patient outcomes may appear to be an internal contradiction. As has been pointed out, however, evidence-based medicine does not advocate a rejection of all innovations in the absence of definitive evidence.

I think BJ is misinterpreting what this says.

Your intentions were indeed misunderstood. Wrong smilie I think. Perhaps we need more winky options than just the usual obvious one.

 

[BillyJoe]

Apology accepted.

 

[fls]

Linda - Thank you! Your words have been sent to the author and as soon as I'll get the answer I'll let you know.

Have you heard anything back, yet?

Do you expect him to answer?

Linda

 

[jli]

Do you expect him to answer?

It is probably easier to recieve an answer (to critical remarks) through a "comment to the editor". But you probably know that already.

 

[JJM]

Phyto wrote "On the other hand, no other so called complementary or alternative discipline has been (and never will) awarded such a status (Homeopathy, Chiropractic, Osteopathy etc.)."

Will never be awarded ... ? Hmm.

"[SIZE=-1]ITALY STRAIGHTENS UP, LEGALIZES CHIROPRACTIC"
[/SIZE][SIZE=-1]http://www.chiroweb.com/world/italy.html[/SIZE][SIZE=-1]
Are the chiros mistaken? [/SIZE]

Any comment? I expect an Italian "doctor" to know these things ...

 

[fls]

It is probably easier to recieve an answer (to critical remarks) through a "comment to the editor". But you probably know that already.

I agree. I just didn't realize that Phytotherapist was going to send remarks that I directed to him (Phytotherapist) on to one of the study authors. Since he went that route, I figured at least I'd see if there was any follow-up.

Linda

 

[Normal Dude]

Somehow I think we have seen the last of phyto. Hopefully I am wrong.

 

[Phytotherapist]

I got the answer from the author and I'll post it as soon as possible (in a couple of days) because I'm too busy with a work that I must finish within two days (the alternative is to pay penalties). I will also answer all the relevant questions. I apologize for the delay!

 

[Skeptic Ginger]

Well I finished the full article. In the end you have a very small sample size and I don't find the study overwhelmingly convincing. Even the non-intervention group had a remarkable decrease in numbers of headache events.

The baseline number of migraines these folks had before entering the study was obtained from a questionnaire. So it is highly likely they overestimated the severity of their disease. By itself, it is no big deal, but it would have led to an exaggeration of the reduction of headaches in all groups. Again, that is OK because they were comparing groups, but if you take the essence of the actual results, the number of headaches prevented is very small and that affects the overall sample size to be considered.

In other words even with ~30 people in each of the 4 groups, if you really had headaches go from 22 to 2, that's a lot but considering the control group (no intervention) went from 24 to 9, it might be reasonable to conclude the real baseline was closer to 9 and 22 was overestimating which is common. Now you have 9 headaches going to 2, 5, 7, & 9 respectively at 3 months and 2, 8, 8, & 9 at 6 months. While you still have a greater reduction in the 'true' acupuncture group, you really need to see this study repeated before getting too cozy with the result.

And if you add in there the fact the original 4 groups, though randomized, had a range of baseline headaches from 22 to 25 +/- 6 with the 'true' acupuncture group already starting out 3 headaches less than the non-intervention group by their questionnaire answers. That could mean there was a larger true difference in the randomized groups than it might have appeared. Again, suggesting the sample size and length of the study were pretty small to be drawing any large conclusions.

It also didn't seem from the description that the control groups were blinded. They had "foam" taped on the sites and the needles stuck in the foam. It didn't say the true treatment group had the same foam with the needles stuck further in. I found that aspect troubling. Did anyone read that differently than I did?