Evidence, Clinical Expertise and Patient Preferences

"I could go on with multiple other examples, but the point remains. For the vast majority of cancers, intensive screening after curative treatment does not result in prolong survival, and, even when there is evidence that it does, such as in colorectal cancer, the survival benefit reported is variable and at best very modest. That means that the overall message to oncologists for most cancers is: Don’t be ordering CT scans every six months or following tumor markers every three months. It’s a viewpoint that oncologists have resisted but are finally coming around to. It’s also a viewpoint that is not popular with patients, as you will see."

 When science- and evidence-based guidelines conflict with patient wishes: What’s a doc to do?

Acupuncture: My Final Word

"Acupuncture has been studied for decades and the evidence that it can provide clinical benefits continues to be weak and inconsistent. There is no longer any justification for more studies. There is already enough evidence to confidently conclude that acupuncture doesn’t work. It is merely a theatrical placebo based on pre-scientific myths."

On the pointlessness of acupuncture in the emergency room…or anywhere else

Cochrane Systematic Review Fails Again

"Cochrane is generally considered to be the gold standard for evidence-based systematic reviews, but their history is dodgy when it comes to unconventional treatments. For example, they famously had to withdraw their review of homeopathic occillococcinum for the flu because they concluded, although the evidence was insufficient to recommend it, was 'promising' and deserved further research."

Acupuncture for Tension-Type Headache

Science-Based Medicine (SBM) Vs Evidence-Based Medicine (EBM)

Most people do not know the difference between science-based medicine and evidence-based medicine.  While the two terms look the same, as science is based on evidence, in practice, the former looks more skeptically at plausibility and challenges the "further research is recommended" mantra regarding research failing to support alternatives to medicine.  This article is a good example of the difference regarding acupuncture, which has zero plausibility and has been repeatedly studied without showing a clinical effect other than placebo.  Under SBM criteria, NHS would have not recommended it so long, if at all.

Acupuncture for low back pain no longer recommended for NHS patients

The Highjacking of Evidence-Based Medicine

"Just because big pharma misbehaves, EBM has flaws, and conventional medicine practitioners don’t always use the most rigorous evidence does not mean that, for example, homeopathy, acupuncture, or energy medicine works."

The “blind spot” of EBM

Science Continues To Self-Correct

"Recently the American Statistical Association (ASA) put out a position paper in which they specifically warn against misuse of the P value. This is the first time in their 177 years of existence they have felt the need to put out such a position paper. The reason for this unprecedented act was their feeling that abuse of the P value is taking the practice of science off course, and a much needed course correction is overdue."

P Value Under Fire