HarryZ wrote:I do understand what you are saying and realize the difference between opinions and evidence based medicine. But what I am saying is that even "evidence based medicine" is subject to various opinions and thus, you can have discussions involving the two. That's one reason why you can end up with some pretty heated threads here and on other boards.
Hi HarryZ, evidence based medicine, by definition should be devoid of personal feelings and biases and its interpretation should be based on the data alone - and not extended to things that the data does not support. This is the definition.
I see your point that no one is perfect and people allow their opinions to get in the way. Keep in mind: as soon as personal biases enter the picture, the debate is, by definition, no longer a scientific one, but an emotional one. The science goes out the window right away. I see this as well so of course I'm aware of it. The only unfortunate part is when patients see these "bickerings" that are not factual and make important decisions based on them that affects their lives. This is not fair to patients who are relying on doctors to remain objective.
Unfortunately, one man's "truth" is another man's "lie". In other words, two different people can look at the same scientific evidence and end up in a heated debate as to what it means. Of course this doesn't happen in most scientific situations but it does happen and "has" happened when it comes to MS theories.
Exactly what you said (one man's truth is another man's lie), is the reason why scientific process was developed, because by definition, humans are biased so relying on anyone's personal opinion, non-experts especially but of course experts (doctors) too, can become problematic.
No one should be getting into heated debates in a true fact-based conversation. If one study found that 50% of subjects reacted a certain way, that is ALL they found; no further interpretation is required about "shoulds" and "musts" until there is more data. If ppl are getting into "heated debates" I automatically know that they are not arguing the evidence, but their personal hopes and fears and biases. The territory of science ended with the simple statement "the study found... blah". The rest is our feelings distorting the data.
I know where you are coming from and I respect your knowledge in the scientific world. But as much as we would like it to be, science isn't always black and white.
Science itself is black and white; people are not. What I mean by that is that a particular study finds a set of data... no one can change that data (hopefully won't)... it is what was found.
A lot of people say that science is not black and white and they justify this by noting that results of several studies are inconsistent. The fact that results are inconsistent is the BENEFIT of science, not its flaw!
The research question I'm currently working on (related to cannabis but details irrelevant for now), has ~200 studies (pretty low for this field). To someone reading the headlines, the studies appear extremely inconsistent... all over the place!
I have spent 2+ years studying that particular literature in DETAIL, every single original article, every single word, variable, location, inclusionary/exclusionary criteria (I looked at 100s of factors from every single study).
As usual, the results were not that inconsistent, IF we recognize that each study was in fact looking at a different aspect without the authors even realizing it! None of them was "wrong" (how can they be "wrong" about patient results; if a patient had a certain finding, they had it; the authors couldn't be "wrong"). It was just that there was some minor factors that early studies were not yet aware of! Once those were taken into consideration, most findings fell into place. It's as if before we were comparing 10 different methodologies/approaches! Apples, oranges and berries...etc! That's why we thought the literature was inconsistent!
This applies to MOST topics. To someone just reading the "headlines", things will seem all over the place. That's why it's best that someone who is specifically involved in that field interpret the vast array of information and summarize it for the rest of the doctors who don't have the time or energy to go through all that.
Inconsistent results are actually the BEST way to figure out the subtleties of human responses and not just surface level generic yes/no answers (which are almost always wrong given that they are too generic).
e.g.: study A reports 75% improvement with Treatment X for MS... Study B reports 10% improvement with Treatment X for MS! Now multiply this by 50 more studies, each giving different values. Inconsistent?! Only if you read just the headlines and leave it at that. Someone who wants the "actual answer" would go into each of these studies, hash out the methodologies, what sample did they use, how did the groups differ, why was it more effective in one sample but not the other? EVERY SINGLE difference in methodology/ analysis/ sample selection is a clue to why Treatment X works for some, why it works for those people... (x 100 more important answers). And the different responses in turn tell us about differences between the various groups (lots of stuff about primary progressive MS for instance, discovered this way, just via differences in responses that were initially unclear). All this just leads to a better designed study that addresses all these concerns.
Then, after enough studies including the "newly discovered variable", the front-line doc treating a patient with MS looks at the published REVIEW/ CONCLUSIONS based on all these studies, asks him/herself "is my patient represented by the sample in this study", if the answer is no, then the treatment is less likely to be indicated; if the answer is yes, then the treatment is "more likely" (not guaranteed) to be indicated.
Sounds tedious and it is. But scientists and docs do this entire process all the time. I wish patients would be more exposed to the behind the scenes so they don't think that docs just go around prescribing whatever they can spell.
In the end, unlike opinions about favourite colours or hairstyles, there IS an answer to whether e.g., Treatment X helps "most" MS patients or not or more importantly whether the "benefits outweigh the risks" (docs ask this every minute of the day but in their minds).
There is a "truth" when it comes to direct questions like "do the benefits of Treatment X outweigh the risks in the majority of patients with a specific characteristic". What people argue is black and white (Treatment X is "good" or "bad") when in fact it is neither.
Each study gives a black and white answer (not good/bad, but just concrete numbers), but no single study EVER can provide final medical advice. That requires many seemingly "inconclusive" (though in reality helpful) studies.