Dear Friends --
I hadn't seen the following before. I have Kathleen's permission to share this, but not her email address . . . so please don't ask me for it.
Perhaps this will lead you to more information on "evidence-based medicine."
In any case, I hope you find the info and the idea helpful.
Hoping you have a wonderful weekend.
hugs,
barb wilkie
www.ehnca.org
=============
Hello, All-- Excuse me if this has already been posted, but, as a lawyer, I gotta love this endorsement of "evidence-based medicine." It gets to the heart of the elements of proof in PREVENTION cases, whether we are engaged in administrative advocacy or litigation or administrative rules-making.
All cases for "reasonable accommodations"--whether under s504, the ADA, or the various federal, state and local Fair Housing Acts--are prevention cases (not liability cases). As I discussed in my earlier post, evidence-based testimony--from doctors, family, friends and the petitioner her/himself--is the credible alternative to futile efforts to satisfy Daubert criteria--which should be recognized as legally irrelevant in prevention cases. (Until that happy day, a record packed with evidence-based testimony will allow you to distinguish Daubert on narrower grounds.) This is a good abstract to give your lawyers, along with a reminder to parse the statutory language and get an abundance of evidence-based testimony into the record.
If anyone (perhaps one of the doctors on this listserve?) can post the full text of this research, I would be grateful.
Kathleen
Abstract: Explanatory and pragmatic perspectives regarding idiopathic physical symptoms and related syndromes
ImmuneSupport.com
04-04-2006
CNS Spectr. 2006 Mar;11(3):225-32.
Engel CC.
Department of Psychiatry, School of Medicine of Uniformed Services University of Health Sciences, Bethesda, MD, USA.
In recent years, research-methods literature mainly addressing controlled clinical trials has arisen regarding explanatory and pragmatic treatment trials. Explanatory trials tend to examine causal mechanisms and questions of efficacy and value internal validity (creating optimal study conditions) over generalizability (using study results to understand treatment effects in real-life patient populations).
In contrast, pragmatic trials value "external relevance" (generalizability) of study results over "internal elegance" so that clinicians and health policymakers can better understand how treatments might impact their patients and policies.
This review draws inspiration from these contrasting explanatory and pragmatic perspectives and develops them for clinical and research pertaining to idiopathic physical symptoms and related syndromes (eg, somatization disorder, chronic fatigue syndrome, multiple chemical sensitivities, irritable bowel syndrome).
Explanatory and pragmatic perspectives are used to examine these idiopathies with regard to causation, case definition, labels, and treatment. It is concluded that idiopathic symptom syndromes are fundamentally pragmatic clinical and research challenges.
For epidemiologic and methodologic reasons, the complex explanations for these syndromes remain largely elusive. Even so, scientific and clinical pragmatism offers the opportunity to reduce disagreement between competing medical disciplines and between clinicians and affected patients with regard to irreconcilable etiologic questions and to remain evidence-based in the care of patients.
PMID: 16575379 [PubMed - in process]
I hadn't seen the following before. I have Kathleen's permission to share this, but not her email address . . . so please don't ask me for it.
Perhaps this will lead you to more information on "evidence-based medicine."
In any case, I hope you find the info and the idea helpful.
Hoping you have a wonderful weekend.
hugs,
barb wilkie
www.ehnca.org
=============
Hello, All-- Excuse me if this has already been posted, but, as a lawyer, I gotta love this endorsement of "evidence-based medicine." It gets to the heart of the elements of proof in PREVENTION cases, whether we are engaged in administrative advocacy or litigation or administrative rules-making.
All cases for "reasonable accommodations"--whether under s504, the ADA, or the various federal, state and local Fair Housing Acts--are prevention cases (not liability cases). As I discussed in my earlier post, evidence-based testimony--from doctors, family, friends and the petitioner her/himself--is the credible alternative to futile efforts to satisfy Daubert criteria--which should be recognized as legally irrelevant in prevention cases. (Until that happy day, a record packed with evidence-based testimony will allow you to distinguish Daubert on narrower grounds.) This is a good abstract to give your lawyers, along with a reminder to parse the statutory language and get an abundance of evidence-based testimony into the record.
If anyone (perhaps one of the doctors on this listserve?) can post the full text of this research, I would be grateful.
Kathleen
Abstract: Explanatory and pragmatic perspectives regarding idiopathic physical symptoms and related syndromes
ImmuneSupport.com
04-04-2006
CNS Spectr. 2006 Mar;11(3):225-32.
Engel CC.
Department of Psychiatry, School of Medicine of Uniformed Services University of Health Sciences, Bethesda, MD, USA.
In recent years, research-methods literature mainly addressing controlled clinical trials has arisen regarding explanatory and pragmatic treatment trials. Explanatory trials tend to examine causal mechanisms and questions of efficacy and value internal validity (creating optimal study conditions) over generalizability (using study results to understand treatment effects in real-life patient populations).
In contrast, pragmatic trials value "external relevance" (generalizability) of study results over "internal elegance" so that clinicians and health policymakers can better understand how treatments might impact their patients and policies.
This review draws inspiration from these contrasting explanatory and pragmatic perspectives and develops them for clinical and research pertaining to idiopathic physical symptoms and related syndromes (eg, somatization disorder, chronic fatigue syndrome, multiple chemical sensitivities, irritable bowel syndrome).
Explanatory and pragmatic perspectives are used to examine these idiopathies with regard to causation, case definition, labels, and treatment. It is concluded that idiopathic symptom syndromes are fundamentally pragmatic clinical and research challenges.
For epidemiologic and methodologic reasons, the complex explanations for these syndromes remain largely elusive. Even so, scientific and clinical pragmatism offers the opportunity to reduce disagreement between competing medical disciplines and between clinicians and affected patients with regard to irreconcilable etiologic questions and to remain evidence-based in the care of patients.
PMID: 16575379 [PubMed - in process]
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