Here is a recap of the stories that appeared last week at Science-Based Medicine, a multi-author skeptical blog that separates the science from the woo in medicine.
Answering a criticism of science-based medicine (David Gorski) Steven Simon criticizes our concept of
science-based medicine (SBM) because he objects to its inherent criticism of evidence-based medicine (EBM); but he sets up a straw man misrepresenting our reasoning. Current EBM guidelines rank basic science knowledge far below the results of randomized controlled trials (RCTs). SBM gives “prior probability” a higher ranking: that doesn’t require understanding the mechanism of a treatment, but it does require not disregarding scientific principles that are based on far larger bodies of evidence. EBM is willing to keep studying homeopathy; SBM rejects further study because homeopathy is incompatible with well-established principles of physics, chemistry, and biology.
Integrating patient experience into research and clinical medicine: Towards true “personalized medicine” (David Gorski) SBM does not mean a physician doesn’t use his own judgment in applying existing medical science to individual patients. Patients’ perspectives must be considered: physicians must ensure that decisions and the trade-offs patients decide to accept are informed by science. This is far closer to true “personalized medicine” than the CAM approach where the practitioner makes it up as he goes along.
CAM and the Law, Part 1 Introduction to the issues (Brennen McKenzie) “If it doesn’t work, why is it legal?” The answer to this question is a complex, multilayered story involving science, history, politics, religion, and culture. This is the first in a series of articles that will try to shine light on the subject.
Chronic Pain: A Disease in its Own Right (Harriet Hall) Chronic pain often outlives its original causes, worsens over time, and takes on a puzzling life of its own. A new book, The Pain Chronicles, by Melanie Thernstrom, herself a chronic pain sufferer, offers a fascinating glimpse into the world of pain sufferers as well as a good overview of our current scientific knowledge.
Vitamin E and Stroke (Steven Novella) Vitamin E has antioxidant effects: it looked like a promising, plausible way to reduce heart attacks and strokes. While foods rich in vitamin E may offer benefits, taking vitamin E supplements appears to do more harm than good. It has been shown to increase mortality in heart disease, and a new study shows that it increases the risk of hemorrhagic stroke by 22%.
CAM and the Law Part 2: Licensure and Scope of Practice Laws (Brennen McKenzie) It’s important to understand legal definitions of the practice of medicine and licensing laws as they apply to conventional medicine, CAM practice, and faith healing. Licensing is a mixed blessing that doesn’t always serve to protect the public.
Of SBM and EBM Redux. Part I: Does EBM Undervalue Basic Science and Overvalue RCTs? (Kimball Atwood) The first part of a response to those who doubt that EBM is deficient in the ways that we at SBM have argued. To EBM, “science” mainly means RCTs conceived and interpreted by frequentist statistics. We at SBM use “science” to mean “cumulative scientific knowledge from all relevant disciplines.” Our call for “prior plausibility” has been misunderstood: perhaps it should be reframed as a lack of prior implausibility.