Maino's Memos: Do We Need Evidence for Everything

Just have 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 paper he states that:"For my patient with acquired esotropia,I needed to hold a decision. Despite the lack of evidence or guidance, I integrated my old experience, my discernment of the scene and the potential for harm, and the specifics of this case to produce a decision.

I decided to take 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 statement that evidence-based medicine is beneficial, and "evidence" is more than the information that can be obtained from RCTs. Systematic reviews have severe limitations . RCTs can lead to fraud 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 lack of solid clinical evidence requires clinicians to invoke critical thinking, communication, judgment, and even intuition on behalf of their patients. Medical training is as much an apprenticeship as it is an education, and medicine as much a craft 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 lack of RCTs not a good idea. We all want science to preserve our diagnosis and treatment but lacking this support we ever should do what Dr. Hunter recommends. He recommends that by integrating our later experience, using our understanding of the figure and the potential for harm, and paying attention to the specifics of the open before us we achieve a decision on how we are going to comprehend 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man is not being hypocritical (See: An Open Letter to David K Wallace, MD, MPH (and other disbelievers and holders of outdated and biased opinions and beliefs) at http://www.covd.org/Portals/0/An Open Letter_DavidKWallace.pdf ) Thank you Dr.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