Monday, March 29, 2010

Science and Passion

Someone recently pointed out that science and passion are not at opposite poles. The goal of finding truth and objectivity are not the polar opposite of 'faith' . For many years medicine has relied on some treatments that are patently useless or at least questionable. We have placed our faith (and the patient's) in some of these treatments.
As medical students we are supposedly grounded in science, and evidence based medicine. The term 'evidence based medicine' to me is meaningless, invented by insurance companies and parroted by some physicians to be 'politically correct' The term evidence based 'science' is far more meaningful. The practice of medicine is and art as much as science. The placebo effect is evidence based, but not scientific. This is pseudoscience. So, evidence based medicine is NOT based on science.
Do I have faith in evidence based protocols? No, not more than preferred practice patterns, which are time related and dependent upon peer opinion. Preferred practice patterns are not scientific, they are based upon location, availability of treatments, and also dependent upon the FDA approving a treatment. As we all know this can take years to occur.
Effective treatments are often blocked or delayed for orphan diseases by the non-availability or unprofitability of producing certain drugs.
Clniical trials often block access to drugs that are highly effective and denied to patients who are dying or otherwise have no alternative for treatment. Clinical investigators are banned from using their individual judgment by Clinical Trial rules that sanction releasing drugs prematurely, even on a very limited basis outside the treatment protocols, which often are restrictive in regard to prior treatments.
Scientific double blinded trials are restrictive. Controlling all variables outweigh the common sense finding at times.
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