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Fwd message: Evidence-based Medicine
Anh Nam tru.c tra(.c ve^` server kho^ng the^? gu+?i mail duo+.c, nho+`
to^i fwd message na`y..
..............................................................................
Subject: Re: Evidence-based medicine
Date: Thu, 10 Jul 1997 19:38:05 +0900
From: Vu Nam <musen212@geisya.or.jp>
To: vnsa-l@csd.uwm.edu
BCC: musen212@geisya.or.jp
References: 1
Hi anh Tuan
> Western medicine and science are largely based on
> experimentation. This is, however, not equivalent to EBM.
> Unlike natural science such as mathematics where the
> Pythagoras' theorem, for example, is eternally true,
> results of experiments are not and are subject to
> advancement of science of knowledge. Thirty years ago,
> oestrogen was hailed as a wonder drug, but it is now in
> doubt whether the drug is associated with breast cancer.
> Thus, EBM is needed to evaluate treatment with all
> available evidence.
Thank you for your elucidation for the term "evidence-based medicine".
After checking the term again I realise that the fact that some clinical
applications based on mechanisms (derived from scientific experiments)
has sometime shown some unexpected outcomes (like the case of using
oestrogen you mentioned) have been termed. I have to admit that I have
not known this term until I read your comment. There has been about over
100 papers using this term, mostly published in 1997, some in 1996. The
fact has been well known but just recently termed. For this
understanding, I also would like to have comment on this.
I see EBM just as a new scientific paradigm or just a new methodology,
new model that has emerged in medicine science over the last decades
basing on clinical observation (the outcome, the side effect of a
method, a technique, a drug et.). It is absolutely not a new concept for
medicine generally. Maybe I have misunderstood by your words of "old
day" and "these day" so I thought you saw it as a new concept for
medicine generally. In fact, Mechanism-based medicine still has a very
very important role in medicine science. Of course, Evidence-based also
has its importance to observe the outcome of any mechanism-based method
or technique or just an application of a drug. The teachers in medical
schools still need mechanism-based medicine (maybe black-white... as you
wrote) to teach their students before mentioning to any new method like
evidenced-based medicine. An evidence-based medicine approach could only
differentiate between solid evidence observed in long-time clinical
application and evidence that is based on a presumed mechanism. So,
mechanism-based M must be a pioneer and hold a basic role for any
clinical application then evidence-based M should be applied later to
observe, to collect evidences (good/bad) until enough to say we should
stop this application (and this is not many).
> I am not sure whether Eastern or traditional medicine
> can be said to be based on experiment from a strict sense.
> I mean, you hear that this herb treats that disease, but
> how does it work, how effective, contradiction symptoms etc
> are not well documented. I may be wrong, but you have to
> enlighten me on this.
For Eastern medicine, it is well known that it bases on the Eastern
thought of A^m Duong Ngu~ Ha`nh to understand, to explain medical
pathology, anatomy, therapy.... While the W. Medicine say pain is caused
by noxious stimulation due to injury, a disease process, or abnormal
function of muscle or viscera, the E. Medicine explain pain as an
obstruction of "Kinh-La.c" system, if this system is no longer
obstructed, the pain will disappear (Tho^ng thi` ba^’t tho^’ng, tho^’ng
thi` ba^’t tho^ng) and induced a pain release method of acupuncture that
stimulate some special points of the body to open " Huye^.t-dda.o"
system. In their pharmacology concept the EM also explain the herbs’
pharmacodynamics by their language like "ha`nh khi’ hoa.t huye^’t",
"bi`nh can, an tha^`n, kie^.n ty`" concerning viscera that are not
exactly the same the air (or gas), the blood, liver, nerve systems
spleen.. in WM.
Of course, nowadays, EM has been elucidated partly under the light of
modern science but it is absolutely not an experimental medicine
originally. You can not bring " no^`i xo^ng ca?m" to a westerners, they
will prefer and believe on Aspirin while a lots of Vietnamese will
prefer "Xo^ng ca?m", "ca.o gio’" no need to known any its scientific
proof, their mother said it is good, so it is good, that’s all. Maybe
evidence-based medicine here..???
> >I wonder if there is any milestone event or period from that
> >you could classify the "old day" and "these day" for this concept.
>
> Well, by the "old days" here I mean back to 50 yrs
> ago or so, where medicine was taught in a clear cut manner.
> Students in those days had to take the words from their
> professors, not much dispute nor argument. These days
> (about forty yrs or so), the American revolutionised the
> teaching of medicine, whereby science was introduced and
> the thinking has been shifted from memorizing facts to
Ø verification of facts.
Ø
I didn't know that. The "revolution" can happen at any time in any field
of science, however, which criteria people base on to call a change as a
revolution is difficult to known.
>The medical
> literature nowsadays is a JUNGLE. There are good, there are
> bad and there are ugly findings. A lot of publications in
> the old days (>50 yrs) ago were simply WRONG, I can list
> 100 of examples like that. EBM was developed to screen out
> the baddies & the uglies and weigh the goodies. But, there
> are limitations as I and anh Huy have stated earlier.
After 50 years, anything can be out of date and become wrong regardless
with or without EBM. But I know a lots of bublications that have been
recognised as a canon, a criterion, like the Pythagoras' theorem they
migh be eternally true.
Vu Nam
Tuan V Nguyen wrote:
>
> Hi Nam,
>
> I am glad that you comment on this. I really want to
> learn more about the methodology of Eastern medicine.
>