User:Fyslee/Definitions

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[edit] Definitions for non evidence-based methods in the health care field

Methods and ideas in the health care field that aren't solidly evidence based (note about that at the end) can be described by various terms. They may overlap, but with few exceptions they aren't completely identical.

Alternative:

Complementary:

Cult:

Dangerous:

Disproven:

Dubious:

Experimental:

Fad:

Fraud:

Holistic:

Integrative:

Malpractice:

Negligence:

Nonsensical:

Nonscientific:

Nontraditional:

Poor medical care:

Quackery:

Questionable:

Scam:

sCAM:

Unconventional:

Unorthodox:

Unproven:

Unscientific:

[edit] Changing status

Even methods that are currently considered to be solidly evidence-based can lose that status if increased knowledge shows that the claims for them have been misunderstood or even false. In that case they join the ranks of the above-mentioned terms. This is the strength of the modern medical paradigm and system - it learns from its history and its mistakes because it records and analyzes them.

This enables it to "winnow" out the "chaff" and internally purify the system from errors it has inherited. It also applies this knowledge externally by holding unproven or new methods at arms length, demanding good evidence before extending approval and acceptance. It's a conservative system that avoids costly mistakes. There are enough of them already, without compounding the problem by uncritically accepting everything that sounds good at first sight.

This sounds good, but to deny that all of the methods that evidence based medicine now uses were once unproven or new is to like trying to deny your own childhood. Agreed that the resistence to openly accept anything that comes down the street is paramount to stability lest yea be led astray. However, claiming to be more efficacious while using similar methods that have not yet been proven just because it is taught in an allied health field smacks of hypocracy and lends doubt as to motives. It undermines the process of productive dialogue and becomes a privacy fence rather than a doorway. -- Dēmatt (chat) 03:51, 10 February 2007 (UTC)

I don't see any such denial, since some methods have always been clearly efficacious and pretty well proven many thousands of years ago, using standards that we would accept today. As far as turf protection goes, absolutely. It is a very human failing that prolongs, sometimes unnecessarily, the acceptance of some methods, but they do get accepted if the proof is strong enough, as Marcia Angell wrote (above). Turf protection does exist on all sides, and can be a significant problem. Somewhere I have written about the Palmers' role in the (relatively modern) reluctance to accept manipulation as a treatment method, even though it was accepted and practiced in the mainstream long before they arrived on the scene. Because of their misuse and false claims, it fell into disrepute. Anything tainted by accustions of quackery gets the cold shoulder. I have written about EBM's relationship to evidence here:

Evidence-based methods are effective, and effective methods should be evidence-based. If a method appears to be effective, then it should be possible to prove it. If the research has not been done yet, it should be. We must remember that "Absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research. - Robert Sydenham. "Lack of evidence in the literature is not evidence of lack of effectiveness."

This is often misunderstood, since it contains two poorly understood elements. The first is that effectiveness exists, in and of itself, regardless of proof, or rather, "before" proof is provided by proper research. The second is that lack of proof doesn't justify the marketing of methods based solely on claims of effectiveness, which are hoped to be proven in the future.

It is one thing to say: "I believe it's effective, but have no proof as yet." It's quite another to say: "I believe it's effective, and my experience with it is enough proof for me and my customers." [1]

-- Fyslee's (First law) 11:39, 10 February 2007 (UTC)

That, of course, suggests that you "trust" the source of the so-called proof (sPOOF;). I think there is a lot of evidence to suggest that some researchers may have some ~~alternative~~;) ulterior motives. -- Dēmatt (chat) 14:52, 10 February 2007 (UTC)

Agreed. There are cases where outright fraud and falsification of evidence has occurred. In other cases (sometimes related) there have been cases of corporate COI issues. Such matters get exposed sooner or later, since research protocols can be examined and compared with other research. Often one should not fully trust evidence or begin to change practice, until the evidence has been (successfully) duplicated by other researchers. None of that even exists in alt med, so no controls are possible. It's usually pure profit without any research costs. It's a far cry from the trust placed on one-case studies, isolated and unusual occurrences, and anecdotal claims that make up the mainstay of alt med "evidence." I generally assume good faith until the opposite is justified, rather than adopting a conspiracy theory mindset. People who adopt that mindset place themselves as god and judge over all things, and it places them beyond the reach of normal logic and discussion. The presence of such a mindset is often a red flag that you will waste your time trying to discuss with them, as normal logic and evidence won't work. The ultimate defense they can always use against demands for evidence is: "Yes, they are so powerful that they can even remove all evidence of their misdeeds. That's why I can't provide evidence." One can just as well immediately throw up one's hands in despair (and disgust) and disengage, as you'd get further talking to a wall. You at least get an echo back from it. Since conclusive evidence is lacking, they usually are experts at ad hominem and straw man attacks. I usually disengage quickly and ignore such people. -- Fyslee's (First law) 11:22, 11 February 2007 (UTC)