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Where are you going with this? The question is a bit ambiguous without knowing what you are looking for.
Linda
Ivor the Engineer wrote:
Ivor, I'm not sure if you're really an engineer but would you also agree with the following...
Bridge Building will improve when motorists trust bridge-builders less and feel free and able to question bridge-builders' opinions and reasoning without sanction... If anything, a bridge-builder's desire to believe he or she practices science-based engineering can be seen as a move to increase power and authority of the bridge-builder over the motorist.
I mean come on, all that talk about logarithms and vectors and loading and moments and sine curves and tensile strength and stuff, it's really only there to intimidate the people who actually rely on the bridge to get from A to B isn't it?
Surely the average motorist is in the best position to determine what makes a good bridge for them and just needs the courage to speak out against the self-agrandising engineers who claim they hold the secrets of bridge-building - but who also happen to be the ones in the best position to profit from maintaining the notion that building bridges requires some sort of special skill.
When you consider that a beaver can dam an entire river without so much as a correspondence-course diploma, you'd have to agree that engineering is over-rated.
Ivor, I'm not sure if you're really an engineer but would you also agree with the following...
Bridge Building will improve when motorists trust bridge-builders less and feel free and able to question bridge-builders' opinions and reasoning without sanction... If anything, a bridge-builder's desire to believe he or she practices science-based engineering can be seen as a move to increase power and authority of the bridge-builder over the motorist.
I mean come on, all that talk about logarithms and vectors and loading and moments and sine curves and tensile strength and stuff, it's really only there to intimidate the people who actually rely on the bridge to get from A to B isn't it?
Surely the average motorist is in the best position to determine what makes a good bridge for them and just needs the courage to speak out against the self-agrandising engineers who claim they hold the secrets of bridge-building - but who also happen to be the ones in the best position to profit from maintaining the notion that building bridges requires some sort of special skill.
When you consider that a beaver can dam an entire river without so much as a correspondence-course diploma, you'd have to agree that engineering is over-rated.
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Ivor the Engineer
Penultimate Amazing
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What I want to know is why everyone who isn’t an engineer uses building bridges as an example of what engineers do when comparing them to medical professionals?
To answer your question though, while a single person may be held responsible for signing-off the work that went into designing and building a bridge, many more people will have performed and checked the calculations and work. I would be very cautious about using a bridge designed, built and checked by a single engineer. Who checks the diagnoses and treatment of a physician?
Physicians are not superheroes, they are human beings. Human beings screw up. A lot.
BTW, no one to my knowledge has ever suggested putting the phrase ‘science-based’ before the word engineering.
quadraginta
Becoming Beth
Perhaps this is cause to reflect. The need to do so with medicine implies certain realities about the ...um, alternatives being offered.
You bring up a good point, but I don't think it's the one you meant to.
"Alternative engineering". I like that.
Mashuna
Ovis ex Machina
Perhaps this is cause to reflect. The need to do so with medicine implies certain realities about the ...um, alternatives being offered.
You bring up a good point, but I don't think it's the one you meant to.
"Alternative engineering". I like that.
Careful, you're in danger of committing a straw house fallacy.
Ivor the Engineer
Penultimate Amazing
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Perhaps this is cause to reflect. The need to do so with medicine implies certain realities about the ...um, alternatives being offered.
You bring up a good point, but I don't think it's the one you meant to.
"Alternative engineering". I like that.
Well there is this piece of satire by Steve Novella, about an Alternative Engineer building a bridge (after all, what else do engineers do?) using only the principles of Fung Sui.
There is no "alternative" medicine, only medicine and ********.
Mojo
Mostly harmless
Well there is this piece of satire by Steve Novella, about an Alternative Engineer building a bridge (after all, what else do engineers do?) using only the principles of Fung Sui.
See also Alternative Aviation:
I don't actually love everything Ivor writes, but this is 100% on. If 5 doctors agreed with the diagnosis and treatment, I'd tend to say it'd be near 100%, but one person makes many mistakes. Given the fact that we can afford five engineers designing one bridge, but cannot afford five doctors for each person, the responsibility falls on the patient to double check their doctor.
That being said, I wouldn't confuse healthy skepticism about prescriptions, including double checking, with 'alternative medicine is good.' There's no need for a skeptic to suddenly turn that off and nod and take whatever pill the doctor wants, but that's no support for poking people with needles to cure them.
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It seems to me that, for the average medical doctor, the percentage of the treatments that s/he prescribes that are clearly efficacious would be relatively small. For example, late yesterday afternoon I got hit by some sort of intestinal bug, and spent a fun-filled evening vomiting. (Yes, I know: It couldn't happen to a nicer guy.
) When this situation befalls my wife, she goes to our family practitioner and diligently follows his advice, including taking any medication that he prescribes (or recommends, if it's over the counter). I figure, why bother? I'll be fine in a few days, whether I go to the doctor or not. So, while my wife may be convinced that going to the doctor speeds her recovery, how does she -- or anyone else -- know?Deetee
Illuminator
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Haven't you watched "House"?
....your point is taken, but I think there are more checks and balances in the system than you realise, particularly as the complexity/severity of the condition increases. For a simple problem, there may be one medical opinion (eg a primary care physician) which is unverified and treatment advice goes unchallenged. Prescription errors will be counterchecked by pharmacy, but they cannot question the original diagnosis.
In a hospital, patients (by definition iller and potentially more at risk of serious disease and harm) are seen and reviewed by a succession of ever-more experienced doctors. There are ward pharmacists who check prescriptions and may even have prescribing rights of their own. There are usually multidisciplinary team (MDT) meetings about complex cases, specialist teams look at individual patient aspects of care (eg the microbiologists or diabetic specialist team) and at least once a week patients are discussed at MDTs (eg radiology/oncology/chest medicine meetings) usually with a clear consensus view arriving from the input of several experienced clinicians. A patient in ITU may get a "second opinion" every 12 hours, as the consultant responsibility is handed over each shift.
That's not to say things work well all the time and that diagnosis is foolproof - it's not. (and then there is always the risk that the radiologist has opted out of doing anything that day because he felt tired and didn't want to risk making an error and being accused of misconduct...
)
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It seems to me that, for the average medical doctor, the percentage of the treatments that s/he prescribes that are clearly efficacious would be relatively small. For example, late yesterday afternoon I got hit by some sort of intestinal bug, and spent a fun-filled evening vomiting. (Yes, I know: It couldn't happen to a nicer guy.
That's the point of controlled trials and objective outcomes.
Linda
Haven't you watched "House"?
....your point is taken, but I think there are more checks and balances in the system than you realise, particularly as the complexity/severity of the condition increases. For a simple problem, there may be one medical opinion (eg a primary care physician) which is unverified and treatment advice goes unchallenged. Prescription errors will be counterchecked by pharmacy, but they cannot question the original diagnosis.
In a hospital, patients (by definition iller and potentially more at risk of serious disease and harm) are seen and reviewed by a succession of ever-more experienced doctors. There are ward pharmacists who check prescriptions and may even have prescribing rights of their own. There are usually multidisciplinary team (MDT) meetings about complex cases, specialist teams look at individual patient aspects of care (eg the microbiologists or diabetic specialist team) and at least once a week patients are discussed at MDTs (eg radiology/oncology/chest medicine meetings) usually with a clear consensus view arriving from the input of several experienced clinicians. A patient in ITU may get a "second opinion" every 12 hours, as the consultant responsibility is handed over each shift.
That's not to say things work well all the time and that diagnosis is foolproof - it's not. (and then there is always the risk that the radiologist has opted out of doing anything that day because he felt tired and didn't want to risk making an error and being accused of misconduct...
There certainly are checks and balances in the system, but as I said, it is simply up to the patient to act as a check on the doctor, especially for the early stages of anything.
Of course a skeptic should be much more skeptical of their own diagnosis, since they're not even a medical professional (hypothetically, I know doctors do go to doctors, but lets not get into that). Therefore the proper thing to do would be to get a second opinion if you believe the first was erroneous.
All I was saying is that Ivor is right when he says it's perfectly fine to be skeptical of doctors (it's also perfectly fine to be skeptical of engineers. If one of them tell you a bridge can't collapse and you're watching chunks of concrete falling off of it, they're probably wrong).
Hellbound
Merchant of Doom
It seems to me that, for the average medical doctor, the percentage of the treatments that s/he prescribes that are clearly efficacious would be relatively small. For example, late yesterday afternoon I got hit by some sort of intestinal bug, and spent a fun-filled evening vomiting. (Yes, I know: It couldn't happen to a nicer guy.
Just to add to this (for Rodney):
The point of most non-emergency, non-critical care is not necessarily to speed recovery, especially fo rthings like common colds, stomach bugs, and flu. The reason she doesn't get well any faster is because that's not the goal. With most routine care of this type, the purpose isn't to make you better: that would cost a lot of money in tests to find out the specific virus or bacteria that was causing the infection, and then the appropriate anti-biotics and/or anti-virals...by which time the disease will have usually run it's course. It's not cost-effective or in the best interest of the patient.
Generally, there are two goals. Often, a broad-spectrum antibiotic might be given, not so much fo rhte primary infection (as most of these are viral-caused) but to prevent any secondary infections while you're ill. The other medicines, such as anti-phyretics, anti-inflammatories, analgesics, cough suppressents, decongestants, and anti-nausea medication, are intended to make you feel better and maintain more function while you're ill.
It's treatment, not a cure. If you're going to compare things, make sure you compare actions that are intending the same effect. If you don't understand what conventional medicine does in something even this basic, it really suggests that you lack the knowledge to make any sort of informed decision regarding it's effectiveness or lack thereof.
To return to my point, Linda and others here don't want to credit Cayce for an efficacious treatment even when the conventional medicine of his time had repeatedly failed to help the patient, and then the patient immediately recovered following Cayce's treatment. But, if you're not going to give credit there -- on the grounds that the recovery just happened to coincide with Cayce's treatment -- how does the average medical doctor fare today using that same logic? Yes, I understand that controlled tests have demonstrated the efficacy of certain treatments for certain conditions, but -- as you note -- in many cases the doctor does not even run the tests necessary to determine the specific condition prior to recommending a particular treatment. So, again, I inquire, for the average medical doctor, what percentage of the treatments that s/he prescribes would you estimate to be clearly efficacious?
Mojo
Mostly harmless
Deetee
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Coincidence breeds superstition and wishful thinking.
Doctor does X. Patient gets better. "Isn't X wonderful?"
Future cases of illness:
Doctor does X. Patient gets better. "X is truly wonderful!!"
Doctor does X, Patient doesn't get better. "Something was stopping X working today, maybe we'll try next week"
This is why it is so important to do proper studies with appropriate controls - to stop you fooling yourself.
The logic isn't the same for a couple of reasons. First, I mentioned more objective assessments. Instead of relying upon the presence of a symtpom and its subsequent waning to tell you whether a disease or condition is present, diagnostic tests, validated measures and systematic documentation prior to the effects of expectation are used instead.
The second reason is more subtle. It is the difference between asking if this is an example of something which has already been established to exist vs. asking whether this establishes the existence of something.
Again, it depends upon what you are asking. Since the requirement for FDA approval is safety and efficacy, 100 percent of the treatments a doctor prescribes are efficacious. But they may not be efficacious for an individual case. Let's take an example. Suppose the evidence shows that when you use drug X to treat hypertension, 10 percent of the untreated group has a stroke and 2 percent of the treated group has a stroke. For every 100 people you treat, 90 would not have a stroke anyway, 8 people are saved from having a stroke, and 2 people have a stroke anyway. Each time you prescribe the drug, it is on the basis that it is clearly efficacious, so you could say the percentage of treatments that are clearly efficacious is 100 percent. But on the other hand, it only made a difference for 8 out of that 100, so does that make the treatment clearly efficacious in 8 percent?
Linda
Ivor the Engineer
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