Posted by alexandra_k on September 23, 2006, at 9:14:37 [reposted on September 25, 2006, at 0:09:09 | original URL]
In reply to free market vs. NHS » alexandra_k, posted by zeugma on September 22, 2006, at 21:59:56
> OK, but not so fast. Because there is a conflict between the biological, mechanistic explanation, and the statistical nature of disease:
> <Evidence can be interpreted in many ways, partly because the knowledge we acquire through clinical trials, especially the RCT, is statistical in nature (meaning that the results are based on effects observed on populations). In combination with the selection of study variables, outcome units, and level of statistical significance, this inevitably leads to uncertainty in dealing with individual patients>
The 'knowledge we acquire through clinical trials' is statistical in nature. Okay. That doesn't mean that disease is statistical in nature, however. They don't seem to be concerned with the nature of disease so much as *given* the kinds of diseases we delimit at present what have been shown to be the most effective treatments (given a little cost benefit analysis including $$$ and time aka $$$ and risk etc)? It might be that they need to rely fairly heavily on their stats because the current kinds of disease aren't adequate. It might be that the information they are taking as 'evidence' is tricky because it is heavily sponsored / conducted / helped along by pharmacutacal companies...
> What I take this to mean is that although supervenience may be true, one is dealing with probablilities rather than certainties
I'll grant you that anyway. While it is controversial there is meant to be some proof that the hidden variable thesis is false and hence there is an irreducibly probabilistic element to the behaviour of the basic entities in physics. Presumably those indeterminacies percolate up to the macroscopic level too... Though if superstring theory comes along... It would be nice to smooth over the indeterminacies. But I take your point, okay.
> The 'numerical method' basicially claims that supervenience can't be followed through, because one needs to arrive inductively at answers to medical questions, and induction has inherent limitations which preclude supervenience.
They said something interesting about not worrying about causal mechanisms about staying away from theory and just sticking to the math. If they want the discipline to mature as a science, however, then they are going to need to get over their phobia of mechanisms, theoretical entities, and theory in general. The germ theory of illness led to significant advances in treatment. You can be eclectic (go with what works or with what the math says works) but that doesn't drive future research in new directions. Theory is what explains and theory is what drives future research in new directions. Theory should offer places where interventions are possible. We might not be able to interveane at those points at present but if people start working on it new treatments could be developed.
The DSM's decision to stay a-theoretical (and actually think that is something to be proud of) is an unfortunate hangover from the psychoanalytic / behaviourist debate (seems to me). Unfortunately... Sciences do progress by moving beyond shoving things together into categories on the basis of superficial features to finding things that share scientifically interesting features in common. Like etiology. Like causal mechanisms. Etc.
Is the use of induction in psychiatry interestingly different from the use of induction in medicine or biology? I don't know...
>Evidence based medicine used for rationing will equally limit the autonomy of both the doctor and his/her clients. In conclusion, it would appear that using practical EBM for cost control may easily become the European equivalent of managed care.>
Of course the drug companies have a lot to gain with being considered first port of call. There is pressure on doctors from consumers as consumers want meds to fix them more meds more kinds of meds more meds to deal with the side effects more and more meds... When the drug companies present their findings (their newly subsidised / funded studies) where their drugs helped people and hence surely it is unethical for a doctor to withold this med from their patients.
Ugh.
poster:alexandra_k
thread:688931
URL: http://www.dr-bob.org/babble/social/20060922/msgs/688951.html