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Medical Forum / General / Nutrition / December 2004Evidence/faith based nutrition/medicine
How can we evaluate the truth claims of people pushing a new fad diet or the next wonder pill or the traditional approaches to asking and answering questions? Here is a hierarchy of quality of evidence when asking about evidence based nutrition/medicine and makes a better informed consumer of information and services/products. Contrast them with the rationalisms offered in place of evidence and/or note that many "alternative" notions don't rise very far on the scale: George D. Lundberg, MD I was recently contacted by an American doctor who asked for some good references on evidence-based medicine (EBM) to help him prepare for a debate with another physician who was opposed to EBM. After recovering from the shock that some 2004 doctor would take the opposing position, I offered him what I thought were good sources, and decided to try to make a succinct case for EBM. Some years ago, the US Preventive Services Task Force^[1,2] determined the hierarchy of quality of evidence to support interventions, such as: 1. At least 1 properly randomized, controlled trial; 2. Well-designed, controlled trials without randomization; 3. Well-designed, cohort or case-control analytic studies; 4. Multiple time series with or without the intervention; 5. Dramatic results in uncontrolled experiments; and 6. Opinions of experts or committees, clinical experiences, and descriptive studies. Thus, the randomized, controlled clinical trial with blinding and sufficient numbers to have statistical power became the gold standard. Recognizing that not all interventions have been properly studied but that physicians must make clinical decisions anyway, David Sackett[3] is credited with having defined EBM as the "integration of best research evidence with clinical expertise and patient values." I consider the near opposite of pure EBM to be pure FBM -- faith-based medicine. St. Paul defined faith as "the substance of things hoped for, the evidence of things unseen.[4]" This was OK for medicine in the first century AD, but in 2004, when there is evidence, I choose it as the basis for my care. That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed. References: 1. Lawrence RS, Mickalide AD. Preventive services in clinical practice: designing the periodic health examination. JAMA. 1987;257:2205-2207. 2. Fontanarosa PB, Lundberg GD. Alternative medicine meets science. JAMA. 1998;280:1618-1619. 3. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. New York: Churchill Livingstone; 2000. 4. Holy Bible, New Testament. St. Paul; Hebrews 11:1. > How can we evaluate the truth claims of people pushing a new fad diet or > the next wonder pill or the traditional approaches to asking and answering > questions? Your public violation of copyright laws was on EBM rather than EBN. Just thought that you might want to know. > Here is a hierarchy of quality of evidence when asking about > evidence based nutrition/medicine and makes a better informed consumer of > information and services/products. Where? Jack LaLanne never participated in any of your garbage. Just thought thay you might want to know. > Contrast them with the rationalisms > offered in place of evidence and/or note that many "alternative" notions > don't rise very far on the scale: 1. At least 1 properly randomized, controlled trial; > 2. Well-designed, controlled trials without randomization; > 3. Well-designed, cohort or case-control analytic studies; > 4. Multiple time series with or without the intervention; > 5. Dramatic results in uncontrolled experiments; and > 6. Opinions of experts or committees, clinical experiences, and > descriptive studies. Total nonsense for those with too much time on their hands. -- john gohde http://groups-beta.google.com/group/Natural-Health > > How can we evaluate the truth claims of people pushing a new fad diet > or [quoted text clipped - 29 lines] > Total nonsense for those with too much time on their hands. > -- nonsense yes but waste of time? More like endless money pit for tax payers and consumers and endless profits for corporations and "researchers" There is no such thing as waste of time or effort in the corporate world. Everything is done for a reason. And that reason is money. To which my answer is "so what?" There are many ways of making money, but most money made by the largest corporations is money made from repeat customers. And every dollar of money a corporation makes from a repeat customer is testament to the fact that the customer has been presented with something he'd rather have than his dollar. That he feels better off having than having his dollar. And that he's made this choice over and over again, after endless chances to think twice about it. Which means, by all evidence, that the customer thinks, after long experience and due consideration, that the corporation has done him a favor and a service and a good deed by selling him what was sold him. And that the customer cannot be convinced otherwise. Every dollar of such money in repeat business is therefore a certificate of gratitude and thanks. Any buiness which makes a dollar this way is entitled to frame it in the same way they would with a letter of gratitude, or a civic award. So don't use "money" as such an expletive, wolfbrother. There's no difference between a dollar bill and a cheer. A dollar, actually, can be more sincere than praise. The phrase "Put your money where your mouth is" has become universal for a very good reason. As also the phrase "Talk is cheap." SBH > To which my answer is "so what?" There are many ways of making money, > but most money made by the largest corporations is money made from > repeat customers. > ... > phrase "Talk is cheap." Are you drunk? Are you hallucinating? Perhaps, if you were to concentrate? The subject of this THREAD is supposed to be EBN, or how does one prove that a particular fad diet works. We are supposed to be talking about research methodology and this luney research doctor babbles on about voting with dollars? Oh, I get it. You think that the Atkins High Protein has been scientifically proven to work because consumers have voted for it with their dollars. Who do you work for? I think that your employers have a right to know about your mental disability. Hey, Gummybear: The thread drift was mostly due to Wolfbrother and his corporation-paranoia. However, you didn't help, as you didn't say anything but call EBM nonsense. That's a really high quality argument, there. Oh yes, and talk about Jack LaLanne. But in truth LaLanne didn't come to his conclusions by divine inspiration, but rather by trying different things and seeing what worked for him. That's not the best sort of evidence, but it is evidence of a sort. In fact, it's #4 on the EBM list. Which you'd know if you'd bothered to read and think a bit, rather than run your floppy chops. SBH > there. Oh yes, and talk about Jack LaLanne. But in truth LaLanne didn't > come to his conclusions by divine inspiration, but rather by trying > different things and seeing what worked for him. That's not the best > sort of evidence, but it is evidence of a sort. In fact, it's #4 on the > EBM list. Ha, ... Hah, Ha! So, running a medical practice, whether it be alternative or conventional, based on clinical experience is called 'Multiple time series with or without the intervention?' Ha, ... Hah, Ha! So, then Quacky antidotal evidence would then be called the first instance of a multiple time series with or without the intervention? Who's side are you on anyway? http://groups-beta.google.com/group/Natural-Health >>So, then Quacky antidotal evidence would then be called the first instance of a multiple time series with or without the intervention?<< Yes, but nothing counts until you've done a multiple time series, and recorded it objectively and without bias. Also, it goes without saying that subjective results on such things don't count unless double blinded. Objective results (such as results from strength testing) need not be blinded. In LaLanne's case, he also gets some benefit from #5: Dramatic results in uncontrolled experiments. Even one-rat experiements are worth paying attension to if the results are well out of the ordinary. For example, LaLanne on his 70th birthday towed seventy boats loaded with 70 people, while swimming shackled. That's an unsual level of fitness. It might mostly be genetic, but it can't ALL be. Nobody gets to be that fit sitting on the couch, no matter what their genes are like. So LaLanne's exercise prescriptions bear careful scrutiny. Whether or not his dietary prescriptions had anything to do with all this, is something else. Though those, too, seem reasonable, actually. My biggest problem with LaLanne is he's one of those people that Rotter would say have with a complete "internal locus of control" picture of the world. Such people, like LaLanne, really seem to think they calls all the shots in their lives. I consider that view childish. Life's a game of poker-- you control how you play the hands you're dealt, but you don't control the deal. I've usually found people who think they do, to be raging narcissists. ("The most important person in your life is YOU!", says LaLanne). Body builders are at big risk for that. SBH > ("The most important person in your life > is YOU!", says LaLanne). Body builders > are at big risk for that. If you are not the most important person in your life than you have my condolences. Just my opinion, but I am right as usual. -- john gohde http://groups-beta.google.com/group/Natural-Health > How can we evaluate the truth claims of people pushing a new fad diet > ... [quoted text clipped - 5 lines] > Some years ago, the US Preventive Services Task Force^[1,2] determined > the hierarchy of quality of evidence to support interventions, such Ha, ... Hah, Ha! You know, 'Toad', doing a job halfway produces substandard results. It would help in the future if you were to supply some decent links. Now, if you could only articulate your position? You have my condolences. :( Now, here is what you should have referenced to begin with. http://www.ahrq.gov/clinic/ajpmsuppl/harris1.htm http://www.ahrq.gov/clinic/ajpmsuppl/harris2.htm http://www.ahrq.gov/clinic/ajpmsuppl/harris3.htm -- john gohde http://groups-beta.google.com/group/Natural-Health "You know, 'Toad', doing a job halfway produces substandard results. It would help in the future if you were to supply some decent links. Now, if you could only articulate your position?" The original was a complete cut and paste, including references used, to an article on a subscription web site. It was presented thus for those not subscribed. Ip provides a basis by which people can evaluate one aspect of how much credability, which is different then opinion, to information they see. This includes yourself as you refer to and post info. If you find some person whose nutritional theology so closely meets your own that it causes you to fall to your knees, second thoughts might be given to making use of it on your pages if it falls off the bottom of the evidence based medical/nutrition reference list. However, you can add to the list by making theology, or faith based, evidence falling from the lips of the sainted as a provisional entry at the bottom with a proper caution that readers not be misled but so only to see where such fits in the reality of things. 'the Toad' wrote: > The original was a complete cut and > paste, including references used, to > an article on a subscription web site. You have my condolences. :( > http://www.ahrq.gov/clinic/ajpmsuppl/harris1.htm > http://www.ahrq.gov/clinic/ajpmsuppl/harris2.htm > http://www.ahrq.gov/clinic/ajpmsuppl/harris3.htm One small step for 'the Toad' and one giant leap for 'the Man.' Not only are my references better, posting them does not violate copyright laws and personal ethics. :) Just thought that you might want to know, Toad! -- john gohde http://groups-beta.google.com/group/Natural-Health 'the Toad' wrote: > The original was a complete cut and > paste, including references used, to > an article on a subscription web site. You have my condolences. :( > http://www.ahrq.gov/clinic/ajpmsuppl/harris1.htm > http://www.ahrq.gov/clinic/ajpmsuppl/harris2.htm > http://www.ahrq.gov/clinic/ajpmsuppl/harris3.htm One small step for 'the Toad' and one giant leap for 'the Man.' Not only are my references better, posting them does not violate copyright laws and personal ethics. :) Just thought that you might want to know, Toad! -- john gohde http://groups-beta.google.com/group/Natural-Health "One small step for 'the Toad' and one giant leap for 'the Man.' Not only are my references better, posting them does not violate copyright laws and personal ethics. :)" Glad I could put you onto some good stuff, once again. "Better" applies to specific use, for quick reference mine was far superior, your's if one wants to muck about in the history and thought details on the topic. The copyright on the web thing is still murky and will be defined, as these things are, by court cases. The pages people can talk to my people about it if they care. 'the Toad' wrote: > How can we evaluate the truth claims of people pushing a new fad diet or > the next wonder pill or the traditional approaches to asking and answering > questions? Well, I am still waiting for you to post the answer. What is your problem, Toad? If this thread is not stupid then how come none of your buddies are replying to it? > Some years ago, the US Preventive Services Task Force^[1,2] determined > the hierarchy of quality of evidence to support interventions, such [quoted text clipped - 6 lines] > 6. Opinions of experts or committees, clinical experiences, and > descriptive studies. So? This ranking does not equate to EBM. Furthermore, this task force did a number of things. This ranking is only one tiny part of it, which this MD clearly took out of context. > Thus, the randomized, controlled clinical trial with blinding and > sufficient numbers to have statistical power became the gold standard. It has always been, so. But, clearly your fellow stupid researchers are still doing and publishing stupid research in nutrition. What? Just exactly who do you think is producing this crap? Jack LaLanne? No, I don't think so. > David Sackett[3] > is credited with having defined EBM as the "integration of best > research evidence with clinical expertise and patient values." These stupid MDs are rapidly making EBM totally meaningless. EBM means virtually anything you want it to mean. That task force was clearly trying to teach MDs without a brain how to think. Everything they do is pandering to people without the balls to put their name on the line by publicly making a decision as to what works and what does not work. Again, Jack LaLanne has been doing this for years. Just thought that you might want to know. That task force could operate for 50 years, and it wouldn't even approach what Jack LaLanne has done without any of your stupid research studies. -- john gohde http://groups-beta.google.com/group/Natural-Health The original post was the answer. For others the obvious might not require comment. By definition of how to spot a "buddy", we are buds. I see now that theology leads you into reformation and counter reformation. If you have a humble question for the author's consideration, contact him. It is possible you know that there can be some variation on this, but the controlled testing always being at the top on any list. Glad we got your brain cells firing on this, will have to see what other such can help also. Will you be linking from your pages, with appropriate commentary of course, to the info you have found? >Well, I am still waiting for you to post the answer. What is your >problem, Toad? If this thread is not stupid then how come none of your [quoted text clipped - 49 lines] >john gohde >http://groups-beta.google.com/group/Natural-Health It's value is not to spot bias, it's value is to evaluate the quality of conclusions reached based on the quality of the evidence offered in support of it. The approach or philosophy by which that conclusion was made is irrelevant. We want to know that it is as high on the list as possible and that our confidence in it is in proportion to the rank on the list. Anyone in the "alternative" world view of things would be treated equally to established approaches. If some homeopathic conclusion can be shown to be an example of the top rank, then we are getting somewhere. Sadly, it rarely leaves the bottom ranks and is often off the bottom,ie. it is in the faith region of quality of conclusions. It also gets us away from the "my opinion is as good as your opinion" nihilism that describes so much medical/nutrition info these days, the higher on the list the less opinion is taken into account and the less personality, guruism, and medical/nutritional theology matters. >While it is somewhat interesting, it still means depending some group >that is fundamentally hostile to your position to make an unbiased [quoted text clipped - 17 lines] >john gohde >http://groups-beta.google.com/group/Natural-Health I introduced the very article you mention on another group, because it is evidence based. They used research where food sources were controled in fone fashion or another so as to see outcomes for various risks. The BMJ, a standard medical journal not an alternative source, was a metaanalysis of these studies as a whole. Wor example, they choose research where almonds was a principle food source and by statistical analysis could determine what apparent effect it had on risk factors. Evidence medicine/nutrition does not exclude food sources in any way for being alternative. It is the quality of the methods used not the subject of the research that makes it evidence based or not. Now contrast that with some many of the alternative reports where some person says several people they see tried something or another and it seemed to have a positive effect for them; as compared to a controlled study of the same thing where as many variables as possible were controlled to better able with more confidence conclude that something was happening.. The article concurs with several others I have seen recently and to others done in the recent past about the same kinds of food sources and risk levels. Because evidence based medicine/nutrrition was a part of all of their conclusions we can have that higher confidence on tthe collective implications. That is normal science. >Witness the polymeal. > [quoted text clipped - 16 lines] >john gohde >http://groups-beta.google.com/group/Natural-Health 'the Toad' wrote: > How can we evaluate the truth claims of people pushing a new fad diet or > the next wonder pill or the traditional approaches to asking and answering [quoted text clipped - 3 lines] > offered in place of evidence and/or note that many "alternative" notions > don't rise very far on the scale: What planet do you live on, Toad? Witness the polymeal. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75% http://bmj.bmjjournals.com/cgi/content/full/329/7480/1447? "To optimise the Polymeal ingredients we used an evidence based diet conceptual framework, which follows similar principles to evidence based medicine.[4]...We searched PubMed, informed by expert advice, for nonpharmacological ingredients with evidence levels 1 or 2: randomised controlled trials, meta-analyses of randomised controlled trials, and meta-analyses of observational studies.[5]...The following dietary elements met the inclusion criteria to be ingredients of the Polymeal: wine, fish, dark chocolate, fruits and vegetables, almonds, and garlic (Allium sativum)." Where there it is, Toad! The polymeat is EBN. So, why are you always whining about stuff that exists only in your close-mindedness? -- john gohde http://groups-beta.google.com/group/Natural-Health |
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