An unnatural act

An unnatural act

I find it erroneous for a site to state Acupuncture does not work, when I have been using it for a decade and can see by experience that it works.

A common justification for use of pseudo-medicines by both providers and consumers.

I sometimes think the words 'In my experience' define, more than any other concept, the boundary between the pseudo-medical world and reality.

Because not relying on experience is probably an unnatural act. What is my favorite burger? Little Big Burger. Favorite shoes? Merrils. Best beer? Probably the one in my hand at the moment, although I tend towards the hoppy. Just about everything I use or like is based on either the experience of myself or those I trust. I suspect it is the same for everyone. But in one area, health care, it is suggested we stop using one of our most basic decision making tools, experience, and rely instead on the results of clinical trials.  Not gonna happen.

Remember most of the weight in an argument goes to the one who has the most experience, ME, who has a decade to study.

In the world of reality-based medicine, the above quote would be recognized as the antithesis of good medical practice when applied to choosing a treatment.

Determining whether an intervention is effective is difficult, especially if the endpoint is subjective like pain. Decades of clinical trials have demonstrated how easily both patients and doctors can be fooled into thinking that an intervention works. It is because of clinical trials we do not, as an extreme example, use internal mammary ligation for treat angina.

In the science-based medicine world we are deeply aware of the huge number of cognitive biases that allow us to be fooled time and again. And more importantly, we try and apply these to our approach to medicine and prefer the quote of Richard P. Feynman

"The first principle is that you must not fool yourself and you are the easiest person to fool."

In medicine experience is invaluable. I am a far better diagnostician and physician that I was 30 years ago when I graduated from medical school. I am better at noticing the subtleties of disease. What those 30 years have not given me is any insight into know what the best therapy is for HIV or how to treat meningitis. That's why I have to read the literature and why, when it comes to treatment, the three most dangerous words in medicine are "I lack insurance." No wait. It would be 'In my experience."

And for those who use and believe in pseudo-medicines?  I suspect no number of clinical trials will convince them that, say, acupuncture did not make them better, that there are other explainations.  

Chico almost had it right: Who are you going to believe?  The literature or your own eyes?

Points of Interest: 3/29/2014
Brain Variations