Evidence-based medicine

We assume that the doctor-patient relationship is based on trust, that patients trust their doctors, and that the doctors are knowledgeable and trustworthy, and that the doctor has access to reliable information, which we think of as truth, and that the medical paradigm is superior to those other healing paradigms because medical science is truthful and evidence-based.

So [exhala] let's look at evidence-based medicine.

The acronym is EBM, and its contemporary manifestations follow, uh, sorry, clinical guidelines.

So this talk grew out of my own long-standing interest in epistemology, but also last year, Ron Schweizer and I were the GP advisors to the Defeat Diabetes study, and we ran education sessions, uh, about low carb for the GPs who had patients enrolled in that study, and a lot of those GPs had no familiarity with low carb.

And some of those GPs were concerned about going against the guidelines, meaning if a patient had an adverse event, such as a heart attack, while they were enrolled in the Dia-- Defeat Diabetes study, would the GP get the blame because they-

So guidelines are now at the center of the modern medical episteme.

And this is what I'm questioning.

Are modern medical guidelines trustworthy? Are they relevant? Should doctors follow guidelines? What happens if we don't? And how do we know what to do when there are conflicting guidelines? But most of all, how on earth did we get here to the point where GPs are in a panic about whether they'll be targeted if they don't follow the guidelines? So we need to know more about the history of guidelines and the EBM paradigm.

Uh-oh

... evidence-based medicine.

Oh, God.

[percussion sting]

[laughs] Oh, God, even Beanie was like...

So evidence-based medicine, for the listeners who may not be terribly familiar with this, but it's essentially what you're trying to do is you're trying to get, like, high quality, mostly, like, prospective studies, blinded, randomized, controlled, blah, blah, blah, and they've been peer reviewed by a series of other experts, and they've gone through the rigmarole of publication.

And you're supposed to use the evidence that we find in that literature to drive clinical decision-making.

One of the limitations that we frequently encounter in veterinary medicine is that our study populations or our study groups within these papers are insanely low, right? Like, there are more than a handful of papers out there that are published with four to six, uh, you know, cats in a group.

No, they aren't running the math, but they are the ones executing the results.

Moving from theoretical equations to real world nursing practice is governed by evidence-based medicine, or EBM.

The core tenet of EBM is to systematically eliminate ineffective and unnecessary treatments from clinical practice.

Meaning we don't just do things because, well, that's how we've always done it.

We do it because the data proves it is the most cost-effective way to generate a QAY.

Last but not least, it took nearly all day Thursday for the Texas House Committee on Public Health to discuss a plethora of interim charges, including social media's impact on youth and infant mortality prevention, while also establishing a new subcommittee on women's health.

The committee kicked off with Chairman Gary Van Dever formally establishing the new Subcommittee on Maternal Health, Menopause, and Access to Evidence-Based Medicine, which will focus on issues related to women's hormonal health.

As lawmakers discussed one of the interim charges, the impact of social media on youth, individuals on both sides of the aisle expressed similar levels of concern over social media algorithms and minors' access to and heavy consumption of content on such platforms.

Several committee members expressed dismay at the various methods by which social media algorithms are believed to be shaped, including, quote, by pupil dilation, how you're engaging with the content and whether it gets your heart rate activated.