from Stephen Bezruchka
---------------------- Forwarded by Dennis Raphael/Atkinson on 08/06/2004
03:51 PM ---------------------------


Stephen Bezruchka <[log in to unmask]> on 08/06/2004 12:28:33 PM

To:    [log in to unmask]
cc:

Subject:    Re: [SDOH] how much of professional health knowledge is
       evidence              based?


Hi Dennis,

I don't have references on EBM.  However, what I say is that for some
reason the ideas of post-modernism (all knowledge is relative and truth is
whatever....) is not considered by the general public to apply to medical
care.  The kind of 80% number used by your quierier is like the same
number used to say that a similar percent of cancers are environmentally
induced.

EBM is another buzz word, like quality in the US.  In the Oxford Textbook
of PUblic Health in the chapter on medical care and health on page 238 of
the 3 volume tome, "The impact of personal medical services on the health
and survival of individuals seems readily apparent.  With modern
investigations and treatments, patients are now regularly saved and make
very good recoveries from infections, injuries, and a variety of other
conditions that were almost uniformly fatal even a few years ago.
Surprisingly it is more difficult to demonstrate conclusively the impact
of these medical advances on the health of whole communities."

As a practicing clinician, most of what we do really doesn't matter, and
where it does, it seems to be able to be done in so many different ways in
which we don't understand whether or not it impacts the outcome.

How do we come to do what we do when we play doctor?  Mostly by how we
were taught.  The results of clinical trials, where they exist, don't
affect much in the way of practice.  I could go on about the UGDP study
that came out in 1976 showing oral agents increased  mortality in Type II
Diabetes.  Didn't change practice a whit.  All we learned from that effort
was not to do studies with mortality as an endpoint.

UBC is asking me to do a whole session in September for their med students
on medical harm. Third year in a row.  Albany Medical College used to have
STephen Grund teach about harm, but I think he is now gone, so that leaves
no school in the US that addresses one of the leading causes of death
whenver it has been looked at.

 Stephen

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]
SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1000+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: http://listserv.yorku.ca/archives/sdoh.html