The Evidence Thing (August 11, 2020)
I wrote the following about four years ago, but it seems to me like it's particularly relevant right now. Plus if there is anyone out there who is still wondering what this "evidence" thing is that I keep talking about and why I am so enamored of it, it might provide them an answer. Plus it's information that's worth revisiting at any time. Plus the newsletter I WAS working on is dreck.
It never fails to amaze me when someone doesn’t care about evidence. Even after lo these many years trotting dazedly down life's path, it still knocks me flat and silences me, however briefly.
Evidence is something that I have talked about here many, many times. I love evidence. That’s because I really like to be right. And as a (former) New Yorker, there is nothing I hate more than feeling stupid. So whenever relevant, before I deliver (or even solidly acquire) an opinion or take a course of action, I go looking for evidence of some kind. That's doubly true in my practice.
By "evidence" I am not talking about fingernail scrapings in a CSI-type police procedural or even the feathers on my cat’s face (“Bird? What bird?”) that give the lie to her innocent expression. I am talking about (in the case of this newsletter, anyway) reliable facts that are for – or against – a lifestyle change, treatment, or even the actual existence and/or nature of a disorder.
Evidence gives proof of something, or is grounds for a particular belief. Some form of it exists in any field that relates in some way or other to material existence (otherwise known as "reality"). And you’d think that that should be easy -- reality is something that everyone can agree on, right?
But, of course, people don’t. And that is the reason that we invented Science. Science sort of changes reality, or at least our viewpoint of it, from something that we potentially should agree on to something that we actually CAN agree on. The rules of Science purport to break through the limitations of our individual viewpoints and get us to the very bottom of things.
Still, because science is a human endeavor, human flaws like prejudice, laziness, self-interest and every other one that you can think of are always present in it. They fill in the wide cracks around the good parts of science like a kind of poor quality mortar, resulting in an edifice that is not nearly as solid as it pretends to be. This is nowhere more true than in medicine.
That is why the movement known as evidence-based medicine sprang up. In evidence-based medicine, an independent group (the most famous one is the Cochrane group) evaluates all the published data for a given subject, and a conclusion is drawn that best fits the available facts. This leads to useful guidelines most of the time, and on any subject that it chooses to speak, evidence-based medicine has a fairly reliable voice.
But there are people who don’t care about any of this. They will ignore everything that science and good medicine has to say about something and go haring down the road after something they heard about from some guy with a bag over his head in a YouTube video. Why, oh god, WHY???!!!
For a couple of reasons. One is that a lot of people just have problems with Authority. This dates back to issues with toilet training and humiliation by teachers in elementary school, and people with this problem should really just get over it.
But there is another, sadder reason. And that is when a medical person whom he or she trusts and looks up to has let them down. Maybe they've been told that nothing is wrong with them when they KNOW that something is not right. Or maybe they've been told that there is nothing that can help them, or that the only solution is something they absolutely can't or won't do.
When that happens, and someone is cut loose by the powers that be right at their time of greatest need, they tend to panic and grasp at straws and believe everything that the lady sitting next to them on the bus last week told them. This is unnecessary. No matter what the situation, you do not have to go chasing butterflies. Because you still have Evidence.
The powers that be may have cut you loose and walked blithely away. But that doesn't mean that you are adrift. You still have Evidence. You can look your problem up all kinds of places, see who else treats it, and go talk to them. Or you can try things that good websites like ConsumerLab say might help you.
None of the possible treatments that turn up may have enough research -- yet -- for inclusion into conventional care guidelines, or to be on your doctor's radar. It takes a long time for something to get from "gee that's interesting" into common use. But that doesn't mean it doesn't work.
You can still look up what evidence there is on something and decide if it's worth your time -- especially if nothing else is working. And -- and this is my main point today -- even a small amount of evidence for something puts it head and shoulders over something that has none.
Just don't ever figure you have 'nothing to lose' by trying a treatment. You have plenty to lose -- time, money, and even your health. So before you try something that seems a little "out there", first find out what the chances are that it COULD help you. That's called evidence, and it's a lot better than just closing your eyes and trusting the Interwebs.
The Cochrane Collaboration, which I mentioned earlier in the article, has done thousands of reviews of different disorders and the treatments for them, evaluating the published research and giving the best assessment possible based on that evidence. Besides the reviews themselves at this link
they have a lot of related resources that have a lot of value for anyone who wants to know the "real deal" about health and medical topics. I recommend them highly, not just for the current pandemic but for any time you are trying to decide between medical or health options.
--dr. diane holmes
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