We don't want good evidence. We want evidence that confirms our biases. We want lies. .

Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

We all rely on evidence. The important difference is __________.

 
There are many people who will tell us that we should not demand evidence as the basis for our decisions, but what is the basis for their decisions?

Evidence, not logic.

We all rely on evidence. The important difference is the quality of the evidence we rely on.

We should not listen to those who are devoted to low standards that can support any bias at all.
 

Yes, you may have dozens of impressive anecdotes, but an anecdote is just the retelling of events with most of the variables ignored. The reader is encouraged to come to the conclusion that is being promoted. Anecdotes should be viewed as advertising – promotion of a product that hides reality.

When we see advertising for a big, juicy burger, we are being presented with evidence. When we go to buy that big, juicy burger, we are being presented with reality. The advertising used evidence to get us to buy their product. The actual sale was when we were presented with the evidence that we are easily fooled and manipulated by those who make money off of our low standards for evidence.
 

Medicine/EMS is just as susceptible to advertising biased promotion of a favored treatment.

Is it logical to choose a treatment (which can harm and/or help) based on weak evidence?

If we are going to risk harming our patients, why are so many of us in favor of such low standards?

Why are we so arrogant that we assume that unintended consequences do not affect our patients?

Maybe our treatments really can’t be tested.
 


 
Image credit.

Or we claim that a treatment is too important to study

For example, epinephrine (Adrenaline) in cardiac arrest.
 

This study was designed as a multicentre trial involving five ambulance services in Australia and New Zealand and was accordingly powered to detect clinically important treatment effects. Despite having obtained approvals for the study from Institutional Ethics Committees, Crown Law and Guardianship Boards, the concerns of being involved in a trial in which the unproven “standard of care” was being withheld prevented four of the five ambulance services from participating.[1]

 

In addition adverse press reports questioning the ethics of conducting this trial, which subsequently led to the involvement of politicians, further heightened these concerns. Despite the clearly demonstrated existence of clinical equipoise for adrenaline in cardiac arrest it remained impossible to change the decision not to participate.[1]

 

Or spinal immobilization.
 

Perhaps it has not been demonstrated safe but it has never been demonstrated unsafe either. Better stay with the known than go to the unknown. If you want to develop a research project, please go ahead and do it. But without proof that they are bad, we cannot just assume that they are bad.

 

That could be the clap for Tinkerbell speech.[2] It could be Dr. Oz justifying his fraud,[3] but it isn’t. This defense of recklessness is from a surgeon who controls trauma policy in EMS.

This was a serious response to my criticism of the lack of evidence of benefit of spinal immobilization. He has studied the effect of oxygen on trauma patients, so he does not apply this Dark Ages thinking to everything.

We pretend that we are not harming patients, rather than find out how much harm we are doing. Everything we do is harmful, but when the benefits outweigh the harms, only then it is appropriate to use the harmful treatment.

We choose to pretend that we are not causing harm.

We can’t even be honest with ourselves.

Footnotes:

[1] Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.
Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2.
PMID: 21745533 [PubMed – in process]

Free Full Text PDF Download from semanticscholar.org

[2] Tinkerbell effect
Wikipedia
Article
 

The Tinkerbell effect is an American English expression describing things that are thought to exist only because people believe in them. The effect is named for Tinker Bell, the fairy in the play Peter Pan who is revived from near death by the belief of the audience.

[3] Dr. Oz Shows How He Lies with Bad Research
Tue, 17 Jun 2014
Rogue Medic
Article

Edited 12-27-2018 to correct link to pdf of Jacobs study in footnote 1.

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Comments

  1. When I read statements like that by physicians, I can’t help but think that as a Medic, I will never gain the elusive credibility that is sought by the vocation at large when the people whose licenses we work under are operating with mindsets like that.

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