The Clinician's Alternative

iCaduceus: Modern Tools for the Eclectic Clinician

"Evidence-based medicine" tries to reduce variations in practice, reduce inappropriate care, and reduce waste by using results of studies of large groups of people as the basis for medical guidelines. On the other hand, some feel that it is bad medical policy to apply general rules to all cases and that medicine requires that the physician use his or her knowledge of the particular patient in deciding on the course of treatment along with the patient. http://www.pbs.org/healthcarecrisis/tough_questn.htm 

 

While evidence-based medicine is important, it appears that insurance companies, malpractice attorneys, drug companies and some doctors hide behind that term without really looking in depth at the research. Just because there is a study about a drug, herb, procedure or other treatment, and it is peered reviewed, does not mean that it is was a good study. And not all people respond the same way to the same stimulus. How do we account for variation? 

 

Evidence-based medicine(EBM) has, over time, become to mean "double-blind study". Clinical experience is considered to be a "lower" form of evidence-based medicine or not recognized at all.

 

iCaduceus: The Clinician's Alternative tries to balance our treatments with both with all kinds of evidence-based research including clinical experience.  Some of the best treatments in the database have never been researched in a double-blind study. For example, duct-tape is a very effective treatment for warts! Many people knew that before there was ever a study. There has never been a double-blind study on the efficacy of parachutes either but people who use them tend to survive after jumping out of an airplane. 

 

Our goal at iCaduceus: The Clinician's Alternative is to present what has been used in the past and has been successful in our experience. We provide research when appropriate. In many cases, there is very good research, in the EBM view,  to support the use of a specific treatment. In other cases, we do not have that but our collective view is that the treatment is effective in our experience.