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Posts Tagged ‘venkat quotes’

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)

 

 

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Further reading 

Here is a book from Dr. Ralf Sundberg, a former general and transplant surgeon, a prolific researcher from the prestigious Karolinska Institue, is trying hard to spill some not-so-sweet truths. A must-read, especially for the heavily biased optimistic scientists.

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One car company  recalls 100s of  thousands of cars for faulty equipment  issues in recent years . It goes on to add , beware , it’s potentially dangerous  . . . please fix it and bring your car at the earliest !

Toyota-Gra

Mean while , scientific medical literature is flooded with dangerous articles, papers and guidelines . . . and  pose serious threat to your patients !

Please search for the junk knowledge and then go on to expose, erase and  ,  . . . and throw it to dustbin ! After all , research is searching for truth , again and again !

Let us welcome a new era , where we shall get alerts about wrong knowledge  withdrawals and reversal ! Let it challenge  the self proclaimed sancto-scientific medical world  and a new medical literature cleansing movement (MLCM) begin in every sub specialty.

One such paper from Yale is linked below .

medical reversal

Finally  . . . the forbidden message !

venkat quotes 2

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Caring shall be an inbuilt character in the  Noble profession ,need not be a value added service or a separate medical specialty !

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As we practice this Noble  (&  Delicate )  profession ,we often tend to Ignore the  warnings  even from our learnt colleagues , Why ?

Wisdom ego quotes brainy best dr s venkatesan top inspirational

 

 

 

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                                           Essential qualification for becoming a great medical  researcher  is  the    “Fine art of  mis-interpretating  data “                                                     Venkatesan sangareddi MD .Chennai .India

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      After  years  of   of experience  I  realised  knowledge and  Ignorance  share  an     intimate relationship !  

       venkat.quotes@2012



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