Part 1 of 4
It can be hard to date the origin of any term. I first heard the term “evidence-based practice” sometime in the late 90’s. It’s an offshoot of “evidence-based medicine,” introduced around 1992.
The idea behind it wasn’t new. The term was. Over the years usage spread into areas tangential to healthcare. That a provider in Western medicine should have proof what they’re doing is effective should be obvious to a modern, Western mind. The scientific method is ingrained into our DNA. Insisting on proof avoids ineffective therapy.
Factors like sample size, margin of error, and population characteristics get considered today. We realize all studies aren’t equal.
You’ll find the term used in psychology, counseling, teaching, nursing, and social work. Sometimes people refer to these disciplines as “squishy” because they make use of “soft science.” Soft sciences, so they say, are full of buzzwords and flavor-of-the-minute concepts. Psychology, sociology, anthropology and the like are soft and not as one of the hard sciences like physics or chemistry.
With evidence-based practice, soft sciences are arguably less squishy than previously.
Whatever squishiness they have comes from their human focus. Humans bring a lot of variables influenced by intangibles like culture and emotion.
The early 2000s were full of innovation along these lines. Trends coincided with the increase and spread of computing power. Statistical analysis of baseball players and other athletes took hold. Businesses started applying this kind of analysis to their data. Developments and products spawned by queueing theory appeared in airlines, restaurants, hotels, and at the department of motor vehicles.
If an airline has ever rewarded you for accepting a later flight due to overbooking, thank queueing theory.
Rather than being less complex, humans with their varying personalities, agendas, and cultures complicate soft sciences.
Between the march of history and changeable humans, evidence-based practice could be a trend like anything else.
- Healthcare costs continue to outpace inflation. In 2018, it increased by 5.6 percent; the year before, 4.6. Evidence-based practice never accounts for cost increases. Evidence to support a turn toward electronic medical records and bar-code medication administration never considered cost. Implementing them necessitated hiring more staff (at the least an IT department and in some places more nurses and scribes), acquiring equipment, and addressing all of the other issues that arose. Implementation solved a few problems (like the misreading of handwriting) and added others like infosec and cyber attacks. As it is, having patient care charts available for easy retrieval across different systems is a dream that frequently remains out of reach due to the wide variety of systems. The end result is the mandate healthcare has to get better at more things. That isn’t easy or inexpensive.
- Non-evidence–based medicine isn’t wholly ineffective. At the very least, treatment based on conjecture and tradition benefit from the placebo effect. Medications get approved by the FDA when they’re shown to be a little more effective than a placebo. A cure is still a cure even when it’s affected by a placebo. With ever-increasing drug costs that means the cost-benefit calculation can be harder to justify. What’s notable is the effectiveness of placebos are improving. It’s not entirely clear why.
- A therapy can benefit some while causing harm to others. What became the opioid epidemic started out with the best of intentions: the belief pain should be treated. As good as these intentions are, these truths have to be reconciled with the fact some people are more predisposed toward addiction than others. When therapies are tailored for individuals, it will be harder to conduct studies on effects and the studies will be less useful with smaller sample sizes. Treatment will be based more on anecdote.
- There’s an ongoing conflict between the general and particular. For example, intellectually, everyone can be aware of antibiotic overprescription and misuse. People can understand that by using only part of a course of antibiotics, the microbes can come back stronger before. They breed resistance. Everyone can understand antibiotics can work against bacteria. Colds are usually caused by viruses, an entirely different class of microscopic infective agent. They can also understand by breeding resistance medicines won’t work when we need them to. None of that feels reassuring to the someone who has spent 75 dollars on a copay. He doesn’t like leaving the doctor’s office without a tangible treatment when he still has a headache, runny nose, and body aches. He doesn’t like being told to rest and drink fluid. He knew that already! If he doesn’t get better for one reason or another in a day or two, the doctor is incompetent! The patient heads straight to social media and consumer review sites to complain about the doctor. Charging somebody for a placebo and pretending it’s an effective therapy is the same thing as lying. Lying is unethical in most situations, including this one. It’s a Catch-22. Similar conundrums repeat themselves with end-of-life care and Tamiflu. The battle of the abstract versus the particular will never end.
Separate Psychic Sensationalism From The Reality
In certain circles, when you say psychic, an image of a conwoman like Miss. Cleo comes to mind. Profiteering psychics aren’t the whole story when it comes to psychic abilities. In fact, when a hospital stay can run someone $100,000 or more who, really, is the profiteer, especially when neither the psychic nor hospital guarantees their work with a money-back guarantee.
For the next few columns, we’re going to take a look at the legacy of Edgar Cayce, a psychic dubbed “the sleeping prophet.”
Born in 1877 in Kentucky, Edgar Cayce was a psychic who gave medical consultations while laying on a recliner. Tapping into what he called a universal intelligence, Cayce spoke on a wide variety of topics such as science, reincarnation, wars and the lost civilization of Atlantis. He also cured thousands of people nearby and from afar while speaking in a trance. Those cures are documented well.
Interestingly, every time he tried to make money off of his powers, he failed, although plenty of others did.
Some have called him the “Father of Holistic Medicine.” Most practitioners don’t purport themselves to have the same abilities, so calling him the founder of that is a bit of a stretch. Cayce said his abilities could be developed by anyone willing to “pay the price” in time and effort.
We’re going to examine the impact of Edgar Cayce in the next post and, after that, try to understand the takeaways for us.
He left a mountain of documentation. Some good sources of information on him are an A&E Documentary, a book: “Story of Edgar Cayce: There Is A River by Thomas Sugrue; and the Association for Research and Enlightenment, a foundation he started to study his abilities (www.edgarcayce.org).
It should be noted that some sources on the Internet are worthless in telling you about the man, his abilities, and predictions. For example, he never specified particular years. If you see a link for “Edgar Cayce’s Predictions for 2019” it’s worthless.
His kind of ability will never be satisfactorily proven to meet standards of evidence-based practice.
The challenge for those who try to remain objective while acknowledging the subjective is to remember a cure is a cure. The result is what matters.
The legacy of Edgar Cayce, perhaps, can give us a window to the future of healthcare especially in a time of ever-increasing costs.