Wikipedia informs me that evidence-based medicine is a movement in the health care community that really only got underways in the 90s. I am not sure I want to know what the health care community was doing before the 90s. I’m not talking about alternative medicine, I’m talking about whatever mainstream medicine was and is doing that doesn’t fall under this label.
Well, until the mid-80′s doctors believed that infants either a) didn’t feel pain or b) wouldn’t remember it anyway (mostly because of this study from the 40′s), so they didn’t use anesthesia for infants when performing heart surgery until someone collected evidence that babies were more likely to live through the surgery if given something to knock them out.
they didn’t use anesthesia for infants when performing heart surgery until someone collected evidence that babies were more likely to live through the surgery if given something to knock them out
Really? I notice (with some relief) that the control babies in the linked study still got anaesthesia; it’s just that they got nitrous oxide instead of nitrous oxide and fentanyl.
I am not sure I want to know what the health care community was doing before the 90s.
On the bright side, some of it was just evidence-based medicine without the branding.
For example, the UK Medical Research Council put randomized trials on the map in 1948 with its randomizedtrial of streptomycin, which had been discovered only a few years before. The massive 1954 trials of the famous Salk polio vaccine also included a randomized trial comprising over 700,000 children. (That said, the non-randomized trial was even larger; the origin of this odd, hybrid study design is an interesting bit of history.)
Quoth said Wikipedia article, in the “criticisms”:
“EBM applies to groups of people but this does not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that “the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand” and suggests that evidence-based medicine should not discount the value of clinical experience.[26] Another author stated that “the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.[1]”
Which suggests that the precursor to EBM is a combination of Education and Intuition. Sorry if I’m not framing it terribly well—there’s an intuitive category in my head for this method, but I’ve never really had to refer to it explicitly. It’s the same technique I use to troubleshoot computer problems—I get a hunch as to what is causing it, and then proceed through a mixture of “safe, generalized advice” (try rebooting!) and “advice specific to the problem I think it is” (aha, you must not have your DNS configured correctly). If both of those fail, THEN I’ll resort to actually collecting data, analyzing it, and seeing where that leads me—“have you had other problems?”, “hmm, let me look up this error code...”
I’ve generally observed this path as the default human behavior, with “call someone else” occurring when they hit the limit of their abilities.
For a lot of the medical advances we had earlier in the 20th century, you didn’t really need to do large-scale clinical studies to see if it was working. You gave someone an antibiotic, and they suddenly got much better. You gave people a polio vaccine, and they didn’t get polio. You took someone’s appendix out, and they didn’t die.
It was really later in the 20th century, when medicine got more and more focused on treating and preventing long-term degenerative illnesses like cancer or heart attacks or high blood pressure, that it became more vital to measure the difference in a large-scale statistical way between how effective different types of treatment were over a long period of time.
For a lot of the medical advances we had earlier in the 20th century, you didn’t really need to do large-scale clinical studies to see if it was working. You gave someone an antibiotic, and they suddenly got much better. You gave people a polio vaccine, and they didn’t get polio. You took someone’s appendix out, and they didn’t die.
Not the best examples, although you’re right about appendectomies! I nonetheless agree with the broader point that decades ago there was less need for fine-grained, systematic medical studies (you were just unlucky in your choice of examples).
Wikipedia informs me that evidence-based medicine is a movement in the health care community that really only got underways in the 90s. I am not sure I want to know what the health care community was doing before the 90s. I’m not talking about alternative medicine, I’m talking about whatever mainstream medicine was and is doing that doesn’t fall under this label.
Well, until the mid-80′s doctors believed that infants either a) didn’t feel pain or b) wouldn’t remember it anyway (mostly because of this study from the 40′s), so they didn’t use anesthesia for infants when performing heart surgery until someone collected evidence that babies were more likely to live through the surgery if given something to knock them out.
EDIT: Removed extraneous word
Really? I notice (with some relief) that the control babies in the linked study still got anaesthesia; it’s just that they got nitrous oxide instead of nitrous oxide and fentanyl.
On the bright side, some of it was just evidence-based medicine without the branding.
For example, the UK Medical Research Council put randomized trials on the map in 1948 with its randomized trial of streptomycin, which had been discovered only a few years before. The massive 1954 trials of the famous Salk polio vaccine also included a randomized trial comprising over 700,000 children. (That said, the non-randomized trial was even larger; the origin of this odd, hybrid study design is an interesting bit of history.)
Quoth said Wikipedia article, in the “criticisms”:
“EBM applies to groups of people but this does not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that “the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand” and suggests that evidence-based medicine should not discount the value of clinical experience.[26] Another author stated that “the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.[1]”
Which suggests that the precursor to EBM is a combination of Education and Intuition. Sorry if I’m not framing it terribly well—there’s an intuitive category in my head for this method, but I’ve never really had to refer to it explicitly. It’s the same technique I use to troubleshoot computer problems—I get a hunch as to what is causing it, and then proceed through a mixture of “safe, generalized advice” (try rebooting!) and “advice specific to the problem I think it is” (aha, you must not have your DNS configured correctly). If both of those fail, THEN I’ll resort to actually collecting data, analyzing it, and seeing where that leads me—“have you had other problems?”, “hmm, let me look up this error code...”
I’ve generally observed this path as the default human behavior, with “call someone else” occurring when they hit the limit of their abilities.
Not a bad plan if you know the limits of your abilities and aren’t trained to act confident even when you’re not.
For a lot of the medical advances we had earlier in the 20th century, you didn’t really need to do large-scale clinical studies to see if it was working. You gave someone an antibiotic, and they suddenly got much better. You gave people a polio vaccine, and they didn’t get polio. You took someone’s appendix out, and they didn’t die.
It was really later in the 20th century, when medicine got more and more focused on treating and preventing long-term degenerative illnesses like cancer or heart attacks or high blood pressure, that it became more vital to measure the difference in a large-scale statistical way between how effective different types of treatment were over a long period of time.
Not the best examples, although you’re right about appendectomies! I nonetheless agree with the broader point that decades ago there was less need for fine-grained, systematic medical studies (you were just unlucky in your choice of examples).