Should There Be A Scientific Basis To Medicine?

Steven Novella addresses the question "Should there be a scientific basis to medicine?"

Cause And Effect

Jonah Lehrer has written an extensive but interesting article for Wired Magazine discussing the problems inherent with the relationship between cause and effect as it relates to medicine.

Pediatrics and Pseudoscience

Harriet Hall has posted on the Science-Based Medicine blog an essay on the problems in pediatric practice.

Alternative Medicine And Evidence-Based Medicine

Is This Ethical?

The New Scientist website has reported that placebos are being used in Germany and Switzerland at an alarming rate.

Folks, this is what you get if the nose of the alternative medicine camel gets under the tent.

A Troubling Finding

The New Scientist website has reported a very disturbing finding regarding underperforming or incompetent doctors.

What Is Needed For Happiness?

What is really needed for happiness? Steven Novella has posted on his Neurologica blog an interesting finding when studying the happiness of individuals with "Locked-in" syndrome, which is almost complete paralysis due to brain damage, but with some ability to communicate.

Cough and Cold Products

Coming into the cough and cold season, the Science-Based Medicine blog has posted an article concerning OTC substances for such. This blogger recommends that all parents read the article in its entirely. Below are the conclusions:

Despite a long history of reasonably safe use, there’s no evidence that traditional cough and cold products have any effectiveness in children. Mild side effects are not uncommon, and fatal side effects are exceptionally rare, but possible. Given that colds are generally mild and resolve on their own, and that no product has ever been demonstrated to have a meaningful effect on the duration of a cold, over-the-counter products, “natural” or not, are unnecessary for children. Rest, adequate fluid intake, and acetaminophen or ibuprofen for the feverish child, may be all that is required.

Homeopathic and other “natural” remedies have emerged as the only marketed alternative — not because they are effective, but because of regulatory double standards and loopholes allow the sale of these products without demonstrated efficacy (or even any medicinal ingredients at all). With the medicinal products pulled off the shelf, they’re the only game in town now. And while homeopathy is admittedly safer than restricted products, given there’s no medicinal ingredients, and they’re not effective, all you can expect are placebo effects. Are parents aware the substitute remedies are just sugar and water?

Pharmacists have some challenges to manage. They may be concerned that the “traditional” products they’ve recommended for years are gone, and embrace the new remedies, without pausing to look for the evidence. Others may rely on marketing, anectodal reports of efficacy, or just read the parent’s desire to have a product – any product, as justification for selling them. And in some cases, they may just recommend these products because it’s profitable to do so. As a pharmacist, I admit that it’s more time consuming and less profitable to reassure an anxious parent that the cough and cold product they’re seeking isn’t necessary. But it’s far more ethically acceptable to me than to sell a homeopathic nostrum or unproven “natural” remedy that has no demonstrated evidence of efficacy, just so parents have the illusion they’re doing something to ease their children’s symptoms.

Effective and Safe Medicine: "Evidence" or "Science" Based?

Regarding the objective evaluation of the effectiveness and safety of a medical treatment, it is a reasonable assumption that "Evidence-Based Medicine" (EBM) and "Science-Based Medicine" (SBM) are one and the same. However, over at the Science-Based Medicine blog, there is a continuing battle between proponents of these two terms.

In essence, proponents of EBM seem focused on the need for Randomize Controlled Trials (RCTs), even if prior research has shown that a particular treatment in question is highly implausible. Proponents of SBM recommend considering the plausibility of a treatment prior to entering into RCTs.

You might say, "What's the big deal?" In this blogger's opinion, the importance of the difference in approaches boils down to two factors. In EBM ---

• there is the time and expense of performing trials on a matter that previously has been found to be implausible. Why the need to do trials?
• there is rarely a finding that an "Alternative Medicine" treatment just simply is bogus. Instead, further trials usually are recommended.

Unfortunately, the NIH and other research-granting organizations are essentially using the EBM approach. Thus, this policy is allowing the waste of time and money to evaluate non-effective "Alternative Medicine" treatments.

Do you feel good about such unnecessary and costly use of resources? This blogger doesn't.

Overuse in Healthcare

Should the overuse of medical procedures be the focus of the debate regarding healthcare reform?