Re: Evidence-based medicine

[Vu Nam <musen212@geisya.or.jp>]

Dear anh Tuan and all

>         For those of you who are not familiar with this
> concept, let me provide you a brief summary. In the old days,
> medicine was taught by experts in a black-and-white manner;
> that is, when the expert says X causes disease Y, you just
> have to listen to him/her. Full stop! These fellows were also
> very powerful in setting the research direction, and of
> course, funding. These days, medicine, just like any other
> discipline, is a matter of knowledge and probability. And,
> knowledge is power. EBM is an idea of combining all available
> knowledge (as published in medical journals) to arrive at the
> best possible treatment. The statistical process of combining
> evidences from published papers is called META ANALYSIS.
> Thus, if you want to know whether mobile phone is DEFINITELY
> associated with cancer, you can go to search for, say, 1000
> papers (some of which conclude yes, other conclude no) in
> medical literature and combine the results to arrive at the
> answer of yes/no.
I think the concept you mentioned above may not be a new one. The
Western medicine but not the Eastern medicine, since its dawn days and
through its long history of development, is always considered as the
experimental medicine, an alternative expression of " Evident-based
medicine". I wonder if there is any milestone event or period from that
you could classify the "old day" and "these day" for this concept.
If an issue is mentioned by 1000 papers, some say yes, some say no, this
issue is still controversial. We can not base on yes/no ratio of these
papers to put a yes/no confirmation for the issue.
Cheers
Vu Nam


Tuan V Nguyen wrote:
> 
> Dear anh Huy and friends,
> 
>         Your comments remind me of an article I wrote in the
> local paper  here last year on the issue of Evidence-based
> Medicine (EBM), which I am sure you are aware of. In fact,
> yesterday, the issue is on again in the national newspaper.
> 
>         For those of you who are not familiar with this
> concept, let me provide you a brief summary. In the old days,
> medicine was taught by experts in a black-and-white manner;
> that is, when the expert says X causes disease Y, you just
> have to listen to him/her. Full stop! These fellows were also
> very powerful in setting the research direction, and of
> course, funding. These days, medicine, just like any other
> discipline, is a matter of knowledge and probability. And,
> knowledge is power. EBM is an idea of combining all available
> knowledge (as published in medical journals) to arrive at the
> best possible treatment. The statistical process of combining
> evidences from published papers is called META ANALYSIS.
> Thus, if you want to know whether mobile phone is DEFINITELY
> associated with cancer, you can go to search for, say, 1000
> papers (some of which conclude yes, other conclude no) in
> medical literature and combine the results to arrive at the
> answer of yes/no.
> 
>         Back to anh Huy's comments. While there is no problem
> whatsoever on the use of synthesis of research evidence to
> search for the best treatment in public health, there is
> problem in applying this concept to an individual. On the
> average, the survival rate or successful rate of a treatement
> may be 80%. However it is an average; there are patients who
> do better than that and there are patients who had worse
> response.
> 
>         The complication is more evident when we consider the
> genetic make-up of an individual. It can be said that all
> diseases have, either in small or large part, genetic
> precipitation (and Diem Quynh will hit me for this). There is
> no reason to believe that the treatment will work for all
> patients in all genetic backgrounds. In fact, there have been
> evidence showing that the efficacy of treatment is dependent
> on the individual's interaction between genetic and
> environmental factors. I mean, if once keeps smoking while
> he/she has cancer of the lung, then treatment will not bring
> a good result at all.
> 
> >Dear friends,
> >
> >Thank you, anh Son and other friends for the diagnostics of Phuong
> >Lien.
> >
> >Given the best current therapy, "standard-risk" childhood ALL
> >(Acute Lymphoblastic Leukaemia) patients have a >70% long term
> >survival rate. The rate for the best prognostic group is around 80%.
> 
>         I guess you have to tell us how long the "survival" is?
> 10 yrs or 20 yrs or more.
> 
> >I don't work in ALL, but a researcher in my dept says that
> >Phuong Lien's white cell count is favourable and she has at least an
> >75% chance of long term survival.
> 
>         This is a great news for her family.
> 
> >Disclaimer: please remember the meaning and limitation of
> >statistics and don't use the above statistics irresponsibly.
> >
> >Huy
> 
>         Wise comment!
> 
>                 Tuan Nguyen