This morning I heard a radio interview discussion that
contrary to the so-called prevailing business trends in companies for
general managers, openness and transparency about their activities, that
Apple, arguably one of the top performing companies, bucks this trend,
selecting specialist managers with expertise and is highly secretive
about what they are doing.
Evidence-based medicine (EBM) is a similarly
fundamentalist ‘truism’ which appears to have been embraced by much of
the medical and pharmaceutical establishment. I have enjoyed ranting
about the failings and imperfections of EBM in various PH Online
Editorials; however recently I read the latest issue of Leon Chaitow’s Journal of Bodywork & Movement Therapies
with possibly the most thorough and learned critique of evidence-based
medicine (EBM) by Anthony L. Rosner PhD LLD[Hon.] LLC.
“Evidence-based medicine (EBM) is beset with numerous problems. In
addition to the fact that varied audiences have each customarily sought
differing types of evidence, EBM traditionally incorporated a hierarchy
of clinical research designs, placing systematic reviews and
meta-analyses at the pinnacle. Yet the canonical pyramid of EBM excludes
numerous sources of research information, such as basic research,
epidemiology, and health services research. Models of EBM commonly used
by third party payers have ignored clinical judgment and patient values
and expectations, which together form a tripartite and more realistic
guideline to effective clinical care. Added to this is the problem in
which enhanced placebo treatments in experimentation may obscure verum
effects seen commonly in practice.
“Compounding the issue is that poor systematic reviews which comprise
a significant portion of EBM are prone to subjective bias in their
inclusion criteria and methodological scoring, shown to skew outcomes.
Finally, the blinding concept of randomized controlled trials is
particularly problematic in applications of physical medicine. Examples
from the research literature in physical medicine highlight conclusions
which are open to debate. More progressive components of EBM are
recommended, together with greater recognition of the varying audiences
This PH Online February Issue 191 is extremely strong
and varied in editorial features, with articles about Crystals, Past
Lives, Hypnosis for Obstetrics and Skin Conditions, Self-Help
Reflexology, Probiotics for a Healthy Gut, Seaweed for Colon Health, How
Allergies can Devastate our Lives yet can also be Overcome, Bodywork
features about how imperfect Cast Removal in Children can result in
long-standing complications and Muscle Energy Techniques (MET) applied
to Knee Pain.
One good thing that has happened is that my partner
Mike’s urinary enlarged prostate saga appears to have come to a happier
outcome than I had been fearing. For those of you who have been
following this mini-saga over the past 3 months or so, you may recall
that as we were publishing the Jan Issue 190, Mike had returned from
hospital, but still with a catheter. In order to lose this intrusive
device he had to pass the urinary trial without catheter trial with the
specialist nurse at the hospital. On 30 Dec, just a couple of days prior
to 2012, he managed to pass the test, albeit with some reservations
from the nurse. So he had to return a few weeks later to repeat this
test, to ensure that he was emptying his bladder.
I am happy to announce that he passed this test again
and has been discharged. The biopsy results on the prostate tissue
removed were entirely benign; his condition has been improving and he is
looking forward to being able to resume his exercises which caused his
hernia in the first place.
I guess one of the lessons I have learned is that as we
get older, the problems we encounter are ones with which we are not
familiar. Long live TURP.
1. Anthony L. Rosner PhD LLD[Hon.] LLC. Evidence-based
medicine: Revisiting the pyramid of priorities. Journal of Bodywork
& Movement Therapies 16: 42-49. 2012.