If you have a BVM (Bag Valve Mask resuscitator), you should not need naloxone. The problem is inadequate respiration, not inadequate naloxonation.

- Rogue Medic

Why Ignoring Evidence Based Medicine Kills Patients

 

Kelly Grayson writes about the use of evidence in EMS. Ironically, he starts by repeating the lie dogma misconception that EBM (Evidence-Based Medicine) requires randomized controlled trials. The rest of the article explains why we harm patients when we do not base our treatments on valid evidence.

Misconception?

The parachute paper states –
 

It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial.[1]

 

A universal truth? No. It is satire, from the yearly issue of the BMJ that pokes fun at medicine.[2]

The most cited article on EBM is more than 7 years older than the parachute paper and is seen by many as the definitive description of EBM. The sub-title tells a lot about what EBM is –

It’s about integrating individual clinical expertise and the best external evidence.

The article clearly exposes the myth that randomized placebo controlled trials are required by EBM.
 

Evidence based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.[3]

 

Yet, the myth of the parachute paper continues to be dogmatically spread, even in an article criticizing dogma.
 

And it’s easy to do, because at the heart of dogma in medicine is our desire to help our patients. It sounds good. The theory was plausible. The motivation was admirable. The goal was reachable. The lie was easy to believe, because every good lie contains a kernel of truth.[4]

 

We want to believe that experience and our memory of what we were taught in school is all that we need.

We want to believe in medicine that is a constant, unchanging benefit to our patients.

The truth is that we need to keep learning and keep improving, because some of what we do to our patients is harmful. We just do not know what part is harmful, yet.

If we do not keep learning, we choose to harm patients. If we do not keep improving, we choose to harm our patients.
 


 

Far too many fervently believe in a treatment because they’ve seen it work with their own eyes.

There’s a reason eyewitness testimony is so easily discredited; because people are fallible.[4]

 

I’ve seen it work with their own eyes. is one of the lies of medicine.

Patients improve, or only seem to improve, for many different reasons.

The patient was already getting better and the last treatment we gave had nothing to do with the patient’s improvement.

The patient was not as sick as we initially thought and the last treatment we gave had nothing to do with the patient’s improvement.

The patient was getting better from one of the previous treatments and the last treatment we gave had nothing to do with the patient’s improvement.

The patient was being harmed by one of the previous treatments and the harm from the previous treatment was wearing off when we gave the last treatment, which had nothing to do with the patient’s improvement.

The patient’s vital signs are not the best indicator of the health of the patient and the last treatment we gave only made the patient’s vital signs look better.

And so on.
 

Go read the full article by Kelly Grayson.
 

Footnotes:

[1] Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
Smith GC, Pell JP.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
PMID: 14684649 [PubMed - indexed for MEDLINE]

Free Full Text from PubMed Central.

[2] Common Sense vs. Evidence
Thu, 28 Mar 2013
Rogue Medic
Article

[3] Evidence based medicine: what it is and what it isn’t.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.
BMJ. 1996 Jan 13;312(7023):71-2.
PMID: 8555924 [PubMed - indexed for MEDLINE]

Free Full Text from PubMed Central.

[4] Faith in EMS: My karma ran over your dogma – It’s not necessary to completely abandon our faith in EMS. But it is our professional obligation to question it.
By Kelly Grayson
EMS1.com
Article

.

Comments

  1. Not spreading the myth of the parachute paper or misquoting it at all. I was well aware it was satire.

    Perhaps the tongue in my cheek wasn’t as apparent as it was for those cheeky Brits. ;)

    Thanks for the link.

  2. It’s exactly this reason that I haven’t seen a doctor in over a decade. I’ve got “COPD” as they call it, and out of three different doctors, they all believe that my development of this disease at age 11-13 was related to my smoking a cigarette or three a day which didn’t start until I was 17, nevermind the overwhelming number of people who smoke a pack or more a day and don’t have breathing problems like mine. I try to tell them, it’s because I have reflux that I’m inhaling while I sleep and they refuse to believe that, even when presented with records of my first ulcer at age 13. I even had a doctor (A DOCTOR!) tell me that the lungs and stomach don’t connect through the very orifice that connects them.

    Oh no, it has to be the pack-a-week and the two to four drinks a week, and have I tried losing a little weight? Oh, and try this new expensive designer inhaler that doesn’t work because it doesn’t address the problem, or try this new drug that he’s prescribing just because it’s on the pen given to him by the drug company’s spiff agent. One of them wrote a prescription for Allegra for me, back when you needed a prescription for it, as though breathing stomach acid is the result of a seasonal allergy …

    I’m about to turn 40 now, and the best thing I ever did for myself was to stop going to the doctor.

    • Ruzho,

      Not all doctors are like that. It is unfortunate that some do jump to conclusions and refuse to reconsider.

      If reflux is the main problem, that does not mean that other things do not contribute, but you can get medication for reflux without a prescription. You can also elevate the head of your bed to help gravity keep everything in the right place.

      .

Speak Your Mind