BMJ 2003;327:1459-1461 (20 December), doi:10.1136/bmj.327.7429.1459
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure: Death or major trauma, defined as an injury severity score > 15.
Results: We were unable to identify any randomised controlled trials of parachute intervention.
Conclusions: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
I got a good chuckle out of reading this. Basically, common sense must prevail over rigid adherence to scientific evidence, development of clinical criteria and other objective quantities. Sometimes EBM can project a total ignorance of human qualities... and I feel that this is the main problem underlying EBM's tense relationship with complementary and alternative medicine (CAM).
EBM and CAM both have the same objectives in mind -- they make the patient feel better. However, one of them demands PROOF. The other just cares if it makes you, the patient, feel better. As it has been shown time and time again, there is a degree of efficacy in placebo, where the mind actually is able to make the body feel better with a useless remedy. The placebo effect is a great friend to CAM adherents, because these people feel like they are regaining some control over their lives and their condition -- in doing something (even if it is nothing) they feel better.
Do EBM and CAM get along harmoniously? No. Do they have to? I don't think so. Orac, the EBM atheist/surgeon and full-time woo-hater, abhors the idea that medical schools have CAM in their curriculum. Even worse, AMSA, the premier med student organization, supports the woo.
I can see why this would trouble him. However, after participating in a retreat with the CAM department at my medical school this past weekend, I am not inclined to take the same hard line that Orac puts us up against. We spent very little time learning about the native medicine. (Which bothered me a lot.) We spent a lot of time learning about the native culture. (Which I have come to realize is the most important part of medicine that we cannot be taught through school.)
I think that it is vital to have CAM in medical school. We shouldn't be "so open-minded that our brains fall out," but at the same time, we need an understanding of these alternative medicines and the culture underlying them so we can be appropriate advisors. We care for the patients and obviously, they care for themselves because they ARE SEEKING TREATMENT... even if it is something that is not science-tested, doctor-approved.
In order to address CAM issues in the clinic, it is important to understand their theories and be accepting, not distainful. (Bedside manner is key!)
It is important to separate the roles of researcher and physician. It is the job of a scientist to be a skeptic -- and a doctor's role is to care. If someone takes their loved one to a reflexologist instead of a doctor with a complaint of "breast lumps" doesn't mean that they are loved any less. It doesn't mean that they are trying to prove something by being different. It does mean that you have to be respectful of their beliefs to regain their trust.
While your opinion is good and you think that it is right... it means nothing if patient has a different opinion of you and allopathic EBM.