LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 13 Nov 2010 09:22:54 -0500
Content-Type:
text/plain
Parts/Attachments:
text/plain (29 lines)
Dear all:

In reading further posts, I realize that I have the same problem with the term evidence-based medicine that I do with other such terms as attachment parenting.  They encompass a style that is often defined differently by different people.  Quite frankly, I have no clue what people really mean when they write "evidence-based medicine", but there certainly seems to be a lot of emotion attached to it.  There seems to be varied definitions of it.  And there seem to be people who think it does not encompass what I think it encompasses.  So, when such loose terms are used, I do believe there are a lot of heated discussion surrounding such terms based merely on different perceptions of what that term means.  I think it would be helpful to use more precise terms when discussing such issues.  Such as, it is not helpful to restrict "evidence" to just clinical trials.  Clinical trials can be flawed if you are looking for side effects and do not have a sufficiently large sample size to detect risks of side effects.  Clinical trials may be biased if data are removed by the researchers because they have 

To be honest, I don't know a single researcher who I have ever met who has ever thought that clinical trials alone are sufficient.  So, I still find the discussions surprising when someone argues that we should NOT practice "evidence-based medicine" when evidence has always included many forms such as naturalistic inquiry and many other forms of qualitative research, case studies (which are anecdotal), retrospective studies, prospective studies, clinical trials and what no one seems to mention -- intervention trials (which encompass much more than magic bullet approaches).  It seems as if there is some secret code to which I have not been privy whereby the definitions of these words have changed and my colleagues in my former days in research were not privy to either.  

Can we please be more specific in our own language even if the media and some amorphous group of which I am unclear seem to have redefined the whole meaning of evidence-based?

Ditto when we talk about therapies?  Can we merely talk about what the therapy is rather than putting it in a box?  I can think of therapies that might be defined as "medical" and therapies that might be defined by some as "alternative" that can be helpful and others that can be harmful (and sometimes even deadly) in both of those amorphous categories.  

Part of the problem I see is that there are some who seem to throw up their hands at the possibility of influencing better research or have the impatience in wanting research to happen more quickly.  The best research takes an incredible amount of thought and time and is actually well worth the effort. These days it seems as if many people want a quick fix.  (I can't help but think of the many years and many decisions that led to the financial crisis and how it seems as if everyone wants it fixed in a year or two.)  The answer is not to just throw up our hands in despair and say it is never achievable.  In the US, there has actually been a marked decline in the ability to do unbiased research over the last 20 years.  This did not happen by accident. It happened due to policies that swung from one end of the pendulum to the other so that we are now in an era of research being predominantly for marketing of products.  It can, and probably eventually will swing back -- but shouldn't we give it a shove?

Yet in fact we do influence the ability for others to carry out quality research every day by our choices to act or not to act.  How many of us actually write our political representatives to demand more funding for unbiased research?  How many of us donate to funds for research on issues of importance to breastfeeding?  Michele Obama has taken on obesity as a cause.  How many of us have written to her to suggest that funds go towards improving breastfeeding and providing funds for research to figure out how to do so on a large scale?  Why couldn't we ask her for money for "operations research".  This is actually in my mind much farther up the chain from speculation, to qualitative inquiry, to association studies, to clinical trials, to intervention trials.  Operations research is really about how to make the interventions work.  Why shouldn't we be able to test out some of our pet interventions so that these are more widely accepted -- or conversely we figure out they didn't really work after all?

Best 

Susan Burger

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome

ATOM RSS1 RSS2