Thursday, April 5, 2012

A balanced post on the EBM vs Alt.Med Debate.

I thought this article balanced and informative. I liked the stated intent "moving beyond virulence" in the title. Of course, Doctors and Friends against Alt.Med did their usual scorn and bile attack in the comments.

"Evidence-based medicine v alternative therapies: moving beyond virulence", 23-March-2012.

Main arguments:
  • The absent patient
  • Lack of critical reflection (on philosophies of health and the politics of medicine)
  • Evidence-based medicine (the critical analysis of EBM)
There is a long comment by 'Anne Cooper', Osteopath, that I thought was good. [click on "show full comment" to see it all]
Her ending is very strong:
So instead of the FoS attempting to take a high moral ground, and at the same time appropriating the term ‘medicine’ (not to mention the title ‘Dr’), perhaps it could instead lobby for funded, high quality research that will enlighten us all as to why these unsubsidised therapies are able to attract and treat so many hundreds of thousands of Australians every day. Now that would be useful. Failing that, their campaign looks to be little more than a turf war.


"His very busy practice is now based on a quite different ontology and epistemology than those of orthodox biomedicine."

"Rather than a “curing disease” perspective, it aims to support the intrinsic energy system of a living body, just like chiropractic, to make people better. This is in stark contrast to the paradigm underlying
modern medical science."

"But most modern scholarship asks critical questions about what knowledge is, and who defines evidence – as well as in what context and in whose interests the answers are."

"Evan Willis has documented such struggles and exactly how the Australian medical profession achieved public legitimacy in spite of internal conflicts. Doctors’ organisations either subordinated (nursing and midwifery), limited (physiotherapy, optometry) or discredited other forms of clinical practice (homeopathy, chiropractic)."

"These critics argue that simplistic over-emphasis on the evidence generated within the experimental, quantitative paradigm of Enlightenment science is inadequate because it diminishes clinical practice."

"The randomised-controlled trials and systematic reviews espoused by evidence-based medicine are also increasingly recognised as inadequate or inappropriate for many aspects of health care.

And some medical practitioners (such as Greenhalgh) have moved on from the dominant scientific paradigm, emphasising new understandings of human bodies as complex adaptive systems."

This is new to me and I think important.
Perhaps it is something that some Doctors in Medical Practice, like Kerryn Phelps' Integrative therapies, could support.

"They’re also consistent with the growing strength of the patient-centred or, more radically, person-centred care movement in quality improvement circles." [PDF]

A related piece on The Conversation, 15-March-2012:
"Homeopathy isn’t unethical, it’s just controversial"

A piece pointed to in the comment:
"Evidence-Based Medicine: Neither Good Evidence nor Good Medicine"

Doctrinal/dogmatic positions on either side are not useful in this debate. It's useful to read an respectfully consider dissenting views.