Several of you have brought up anecdotal/experiential evidence as being a vital base. I whole-heartedly agree with this. There are many concepts and practices that are very reliable and truly do work and simply because they have not been tested in a clinical study does not mean they are any less true or reliable. In truth, many research studies were born out of anecdotal evidence, so that is another way in which anecdotal absolutely has its great value. What I also look for in my approach to specific information is something that (when possible) has objective and definitive use, especially when it is a problem or concept that is new to me or one that I have to teach to others. I do not degrade the importance of anecdotal evidence nor do I worship scientific research.  I see that each has its own strengths and limitations. The strength of anecdotal is that it can be applied and observed first-hand using both intuition and the senses and that it can prove itself to be true even if research studies can’t find a reason why. Intuition and individual adaptation are very important in real life clinical applications. Beth, you gave the great example of CST, how you have seen it work in your practice yet there isn’t the written studies that have backed up the practice, but that in no way implies it doesn't work (or maybe not many studies have been done to date? I don’t know…I am certainly no expert on this, merely familiar with the CST concept and don’t know much about the actual practice;)) One limitation of anecdotal evidence is that it doesn’t necessarily allow for excluding for other interventions/contributing factors. When several therapies are being applied at one time which is often the case, how do we know which ones are working or working the best? We can’t know just based anecdotally if X actually was effective if X is being used with Y and Z and whatever else. Another limitation is that a therapy that works famously for one person may have no benefits for another (the same limitation can also exist in applying research as well). So anecdotal evidence, just as research studies cannot be applied generally to everyone. Does that make sense? Again, I am not in any way devaluing anecdotal evidence, simply I am making the point that just like clinical studies have their strengths and limitations, so can anecdotal evidence. All these forms of information can be used to decide what should be done in clinical practice, but they each have different strengths and limitations as well. I firmly hold to research being a useful tool and please note the careful use of the term tool (something that is used to facilitate operations, it is not the end all be all). Certainly, deeply flawed research is not reliable nor is it useful, but it is not a fact that all current research is flawed. There is good (not perfect) research out there. I appreciate Jennifer your points about starting with the therapy that will have have the least harm. We do need to choose that which harms the least, yet can still be effective. ,
 
            Thanks, Jennifer very much for responding and thanks for sharing your story about your son (and happy birthday to him:)). Many of your comments helped me to better understand where you are coming from. I greatly relate to your frustration with blind trust in an at times nebulous forms of "science" or "experts" or only trusting one specific model of health. This gets me going as well. As to the mention of absolutes, it is one that I specifically did not intend to start as a discussion. It was mentioned merely to give others a frame of reference of where I personally was coming from, but is not really part of the discussion at hand. Please know, I am not attacking you, I just want to have a real discussion on these issues and know what others think, so I appreciate you sharing. 

I don’t mean to imply that offering a better option to a physician’s is bashing the profession. But a message of simply offering a better option is not the message I am getting from posts. I am having a hard time seeing professional, collaborative messages when I read comments about how such and such a profession knows nothing about X (as you mentioned a couple times in previous posts). I whole-heartedly agree about not making assumptions about a person’s background. But, are assumptions about a person’s background not being made with comments such as that (physician’s know nothing of X?)? How can one so decidedly know that a certain individual professional knows nothing of X unless they specifically know that practitioner? Many times people have made assumptions about me simply because I have a nursing background and they conclude without ever asking me that I know nothing of things like nutrition or herbs, and that I am a staunch, unquestioning believer in all things medical and scientific etc. I came from a decidedly non-medical background growing up, and later attended a very holistic nursing school, so I see merits and weaknesses to varying viewpoints on health. I absolutely think we can critique other practices in other professions and assess which practices are useful and which are not, and those which are downright harmful and that this is not bashing. But that’s not what I am getting from the tones. My request concerning divisiveness is more directed at the overall tone and the choice of words used, which has, to my disappointment again been reiterated in your last post. I am not disappointed at the fact that provocative points are being raised--to the contrary, please keep that up! To be totally honest though, I have been surprised at the inflammatory tone at times on various postings, not just singling you out. You have great information and experience and make great points and I want to learn from you. But I really have been turned off when inflammatory comments are made by anyone—this happens all over, not just on this forum. My disappointment has nothing to do with the provocative nature of the information itself or the fact that so many of us have varying perspectives, at times opposing perspectives, which I see as a good thing). Rather, I find that provocative words and tone that are used can be so inhibitory to a real discussion and more importantly, they do not foster patient advocacy, they actually limit truly informed consent. I think the tone in which we say things is every bit as important as the message itself, in particular when speaking to those who are seeking us out for help. I sense your strong tone and don’t ask anyone who feels passionately to somehow not be passionate (how silly would that be), but we absolutely can be professional and and provoke new thoughts and perspectives without being incendiary. I really am sorry you see the issue of divisiveness as a straw man and worthless discussion. But, that view does illustrate why I brought up the admonition in the first place. Perhaps that view is the very reason why the discussion is continually being resurrected. 
 
To Jennifer and all, I have found the discussion on evidence very stimulating and thanks to all who have contributed thus far!  And I just saw your second post, Melissa, and I agree, it can be so much effort to have these important discussions! My brain has had more than a work out:)

Deborah Wetherill, RN, BSN, CCCE, Lactation Counselor, Colorado, U.S.
Typing rather slowly as I share my arm with a BF babe...

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