Posted in bio ethics, Ethics in Medicine, evidence based cardiology, Medcal research, Medical education, Medical ethics, medical quotes, medical satistics, Two line sermons in cardiology, tagged evidence based falsehoods, evidence based lies, evidence based medicine, evidence based nonsense, experience based truths, principles of medicine on October 3, 2021|
Is there a solution?
As I understand, we don’t have any. Maybe, we can try this. No way, I can prevent it from appearing ridiculous for the mainstream scientists.
Truths often lie silently buried deep (many times intentionally). They definitely deserve an intellectual resuscitation beyond the dirty world of data and evidence. Further, why should experience be considered as enemy of evidence ?
Posted in Ethics in Medicine, evidence based cardiology, Medcal research, tagged duplicate medical research, ebm, evidence based medicine, finger criteria, how to do medical research, how to right a scientific paper, junk research, medical education, medical research ethics, rct randomised control trial, research methodology, student t test on September 11, 2021|
There are about 30000 scientific journals and two million papers every year. Of which 5000 are in medicine (Ref : World university news)
Now, take a deep breath and answer this query. What do you think is the most important aspect of any scientific or medical research in the current era ?
Final message
With due respect to all researchers, What do you think is the most important aspect of any scientific or medical research? This query is very much relevant today. All components are equally important is an easy way out. But, that’s not the pathway that will take us to the truth.
Postamble
Having answered the above question, no way, we can escape from this question –“Which could be the least important component “?
I guess you got it right. In the current scenario, my choice is striking and is sandwiched in the middle of the 7 responses..
Posted in evidence based cardiology, health economics, Public Health, Public health issues, Social medicine, Uncategorized, tagged acc aha scai esc guidelines, class 2a vs 2b indication, Class 2b Indication, Comparative efficacy, cost effetiveness, dr venkatesan, evidence based medicine, health economics, health outcome analysis, levels of recommendation, venkat quotes on July 8, 2021| Leave a Comment »
Evidence-based medicine (EBM) is being projected as a scientific God’s secret specialty. Physicians who don’t follow EBM are considered unfit non-professionals. Presumably, in pursuit of truth, all those glamorous official bodies in cardiology bring out umpteen number of protocols, guidelines, advisories, and recommendations.
The blueprint for EBM
We have the famous 3 levels of recommendation backed up by different levels of evidence. Many of us trust these as the jury’s final verdict for most illnesses in cardiology. I would like to bring one particular issue about this hugely popular model of EBM. It is about one specific class of Indication referred to as 2b. The other day, there was an intense argument for an ICD in a young HCM patient and CRT in DCM based on this 2b stuff. Kindly request all of you to pause for a moment and introspect. We can realize, class 2b plays a mischievous game in EBM with the English language “may and may not”. It tries to push subconsciously an interventional bias from equipoise, in spite of lack of good evidence and clear divergence of opinion and a possible trend towards harm.
Further, there is widespread reluctance in many cardiac workgroups to refer class 3 recommendations as an absolute (or at least relative contraindication) It was strange to note one of my colleagues argued that, class 3 is also a fair recommendation, to accept or reject is in our domain. I was initially shocked to hear that but had to agree with him ultimately as we realized a significant chunk of interventions we do, like delayed PCI > 24 hrs, CTOs, and chronic stable belongs to the proud class 3 recommendation. The debate came to a funny end when a senior cardiologist confessed somehow class 3 seemed to be a lesser evil than even class 2B.
Final message
For the sake of our patients, we need to bring an urgent reform in the EBM. Let us merge class 2b with class 3 and put it in a single basket and keep it out of reach to all tempting stakeholders. We shall display only class 1 in our therapeutic showcase.
Counterpoint
(*Dynamic recommendations is the norm in science, as we accumulate evidence with time.. Agreed, let us do this silently in research labs. Don’t bring it to practical guidelines. No, can’t agree. Freedom to indulge with an experimental modality in a no-option patient must always be there as we are able to give the benefit of doubt to these helpless patients. This is a valid argument but we must not forget even in dire situations good option need not be a compulsive action, it can be in action as well)
Posted in Cardiology -guidelines, Ethics in Medicine, Social medicine, wisdom in cardiology, tagged comparative effectiveness, cost effectiveness, cost ineffectiveness, drsvenkatesan, evidence based medicine, health budget of a country, health care indices, health care wastage, health economics, junk science, medical quote best, outcome analysis, quality of health care on June 28, 2021|
Posted in Uncategorized, tagged art of healing, best book in medicine, cost effectiveness in medicine, definition of medical care, ethics in medicine, evidence based medicine, harrison principles davidson, medical education, medical science is an art or true science, nursing vs medical profession, principles of practice of medicine on May 30, 2021|
This 90-second video clip is a “perfect provocation”
Allan Savory is a renowned ecologist from Africa. He is a global leader in environment and eco protection. He is making this famous comment, during one of his interviews from the deep forests of Zimbabwe, after years of ground-level work in the field of desertification and climate change. I can understand his feelings, as we also encounter similar situations at ground zero of the health care delivery system. (I wonder if there is anything called peer-reviewed bedside caring)
We realize wide gaps between academia, patient care, and research are the norm, not an exception. One reason for this is, even well-learned medical professionals find it difficult to comprehend, that the practice of medicine is essentially an art, administered with love, care, service-mindedness. A cost-effective infrastructure with an immense amount of teamwork is critical ( Of course, guided by a fair amount of knowledge, expertise based on good scientific principles)
Final message
As Savory says, let us hope, the future looks bright, that welcomes young researchers from the fringes of the scientific community. Let them be conferred with all courage and resources to course-correct medical science from its frequent aberrant and awkward turns.
Posted in bio ethics, Cardiology -Patient page, cardiology -Therapeutics, Clinical cardiology, general medicine, Medical education, Medical ethics, medical quotes, Two line sermons in cardiology, tagged clinical acumen, dr venkat quotes, ethics in medicine, evidence based medicine, guidelines protocols, principles of practice of medicine, rcts in medicine, william osler on March 31, 2021|
Posted in Cardiology quotes, cardiology-ethics, tagged best medical quotes, dr venkatesan quotes, ethics in medicine, evidence based medicine, evidence vs experience based medicine, hippocrates ethics, limitations of ebm, medical education, medical ethics quote, medical industry, principles of practice of medicine on February 13, 2021|
Because . . . its current course is not always in the right direction & not everyone is ready for course correction as well!
Reference
Posted in Uncategorized, tagged bioethics, dr venkat quotes, ethics of medicine, evidence based medicine, future of medicine, hippocratic quotes, practice guideline for medicine, principles of practice of medicine on May 19, 2019|
Somehow the concept of Evidence based medicine (EBM )never excited me in spite of great strides it has made. Probably the main reason for this is, EBMs origin, quality, and credibility is currently severely compromised. (Though It appears to ooze science 24/7 and make us believe in it too !) Herewith, sharing some of the forbidden thoughts(with lots of pun) for a (un)successful practice of EBM. This is definitely not meant for young and novice medical professionals. Strictly for the ones who can segregate sense from non (S)
Reference
Posted in Cardiology -guidelines, Infrequently asked questions in cardiology (iFAQs), tagged evidence based medicine, guidelines vs recommendatios, instituional protocols, medical ethics, protocols on February 21, 2015| Leave a Comment »
In this era of synthesized evidence base, one of my intellectually aberrant student asked How can we indulge in a popular coronary procedure with class 1 indication backed by level C evidence ? (As defined by the seemingly invincible guideline committee of various International cardiology organizations .)
I told him ,
Finally , realise Individual decisions based on sound scientific understanding with zero non academic intrusions will be revered forever !
*Caution : If you think you haven’t yet reached that the level of individuality , come what may , you are expected follow these advisories which are primarily aimed at providing quality care and you will be pardoned of any adversaries as well !
