Maino's Memos: Do We Need Evidence for Everything

Do We Need Evidence for Everything

Just take an article, Do We Need Evidence for Everything? by David G. Hunter, M.D. Ph.D. in the American Orthoptic Journal, Volume 60, 2010. In this newspaper he states that:"For my patient with acquired esotropia,I required to have a decision. Despite the want of evidence or guidance, I integrated my old experience, my apprehension of the prospect and the potential for harm, and the specifics of this type to create a decision.

I decided to shoot each medial rectus muscle with fi ve units of botulinum toxin."In this article's abstract he goes on to say: "There is no randomized, controlled trial . supporting the argument that evidence-based medicine is beneficial, and "grounds" is more than the data that can be obtained from RCTs. Systematic reviews have serious limitations . RCTs can contribute to fake or contradictory conclusions. . controlled studies enroll .highly selected groups . yet real patients bring with them an abundance of messy heterogeneity. . we should not withhold potentially beneficial treatment simply because we lack randomized controlled trials. The frequent want of solid clinical evidence requires clinicians to invoke critical thinking, communication, judgment, and even intuition on behalf of their patients. Medical education is as much an apprenticeship as it is an education, and music as often a cunning as it is an art."Finally. a medical colleague, who putting politics and professional jealousy aside, states what we health care providers know to be true. Having RCTs back up what we do is awesome. Withholding treatment because of a miss of RCTs not a right idea. We all want science to keep our diagnosis and treatment but lacking this support we ever should do what Dr. Hunter recommends. He recommends that by integrating our late experience, using our apprehension of the forecast and the potential for harm, and paid attention to the specifics of the subject before us we reach a conclusion on how we are leaving to cover the presenting disorder.At least this fine man is not being hypocritical (See: An Open Letter to David K Wallace, MD, MPH (and other disbelievers and holders of outdated and biased opinions and beliefs) at http://www.covd.org/Portals/0/An Open Letter_DavidKWallace.pdf ) Thank you Dr. Hunter. DM