Medical Solipsism

2018 ◽  
pp. 195-203
Author(s):  
Erwin B. Montgomery
Keyword(s):  
Evidence Based Medicine ◽  
Procedural Knowledge ◽  
Regulatory Agencies ◽  
Evidence Based ◽  
Randomized Control Trials ◽  
Medical Systems ◽  
Randomized Control ◽  
The Individual ◽  
Based Medicine ◽  
Individual Clinician

A conventional notion of knowledge is explicit and declarative statements of objective facts and principles. Procedural knowledge, such as riding a bike, is evidenced by it having to be learned. Knowledge includes the corpus of medical facts and principles as examples, but so is how the facts and principles are used. Medical facts and principles can be justified by referring to research and study. How does one justify how one uses facts and principles? The lack of clarity opens the discussion to solipsism—a claim is true because one believes it to be true. When involved, solipsism ends the discussion and with it any hopes of progress. The only protection is holding the person responsible for the consequence. There are many situations where solipsism may arise, including evidence-based medicine that recognizes only randomized control trials, governmental regulatory agencies, balkanized medical systems, and, most importantly, the individual clinician.

Introduction

2018 ◽  
pp. 1-20
Author(s):  
Erwin B. Montgomery
Keyword(s):  
Evidence Based Medicine ◽  
Historical Analysis ◽  
Evidence Based ◽  
Randomized Control Trials ◽  
Logical Deduction ◽  
New Knowledge ◽  
Objective Tests ◽  
Randomized Control ◽  
Logical Fallacies ◽  
Based Medicine

The critical and historical analysis of medical reasoning begins from the central importance of certainty in practice and research. The need for certainty manifests in preference for objective tests, particularly their overutilization, and evidence-based medicine used synonymously with randomized control trials. The variety of manifestations in each patient and each subject of research is a challenge to certainty. The response is a choice of epistemic perspectives. Either there are as many “diseases” as there are patients, or there is an economical set of diseases, defined by principles and facts, by which any patient can be understood. The latter suggests a type of logical deduction, and deductive logic is indeed the model. However, deduction, while providing certainty, does not generate new knowledge. Rather, derivative logical fallacies must be used that provide utility at the expense of certainty. Similarly, induction also is problematic. The implications of the conundrum and responses are introduced.

scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior
Keyword(s):  
Health Insurance ◽  
Evidence Based Medicine ◽  
Private Health Insurance ◽  
Scientific Evidence ◽  
Federal Court ◽  
Public Healthcare ◽  
Evidence Based ◽  
Unified Health System ◽  
The Individual ◽  
Based Medicine

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

Why, in medicine, evidence is still more important than narratives or values? Or “The importance of being evident.”

2017 ◽  
Vol 5 (3) ◽  
pp. 357
Author(s):  
Marie-Caroline Schulte
Keyword(s):  
Medical Treatment ◽  
Evidence Based Medicine ◽  
Population Based ◽  
Evidence Based ◽  
Research And Practice ◽  
Actual Patient ◽  
The Individual ◽  
Based Medicine ◽  
Do So ◽  
Evidence Hierarchies

The importance of being evident is what counts for medicine. The diagnosis must be evident and the treatment must be based on evidence. If that evidence is and always must be based on statistics, as we have seen, it becomes questionable. Evidence is good when it is robust and when it fits the individual patient. Only then does evidence-based medicine (EBM), make sense and only then the patient can be sure to be treated in the best possible way. EBM, the movement of medicine that is strictly based on evidence which is judged in a hierarchical order, is under scrutiny and heavily criticised, chiefly because it has lost the patient out of its focus. Numbers are more important than the individual diagnosis and treatment is administered according to population-based statistics and not ‘made to order’. Although this criticism is very valid, the solution cannot be to simply replace EBM with something else, but the solution must be to still base medicine and medical treatment on the best available evidence we have, while putting the patient back into focus. In order to do so, it is important to topple evidence hierarchies, to divide EBM into research and practice and to acknowledge that sometimes the statistical best evidence is not the best evidential treatment for the actual patient.

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