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A call for different approach to evidence based medicine | Evidence based medicine is advocated by people with little understanding of medical practice. They hardly realize that normal clinical practice is essentially evidence based (EBM). Their so called pursuit of perfection has made things difficult for every-one. The picture shows a doctor practicing clinical medicine with the help of a laptop | EBM, Evidence Based Practice, Evidence Based Medicine, Doctors, doctor, health, healthcare, law based medicine, medical, medical practice management, medical services, medicine, Medical malpractice,

A call for different approach to evidence based medicine

A call for different approach to evidence based medicine (EBM)!

Legalization of Medical Practice

I think concept of evidence based medicine has been taken to ridiculous proportions. It is impractical for day to day situations. According to this concept a clinician who normally encounter a myriad of situations is required to keep himself updated all-the-time with legally acceptable latest evidence emerging by way of trials and expert guidelines. Effectively this call for evidence based medicine (ebm) transforms medical practice into “law based medical practice“.

Antithesis to Law based medical practice or EBM

pyramid of evidence based medicine 300x204 A call for different approach to evidence based medicine

Pyramid of evidence based medicine

Medical evidence is usually mutually contradictory.  So normally the poor treating doctor has to differentiate among various disease entities and exercise his discretion and judgement in choosing what to follow and what not to follow. This is called differential diagnosis. And in this the entire concept of so called evidence based medicine meets its antithesis. In interpretation of clinical evidence, a doctor normally relies upon logic, medical knowledge and experience. It is not possible to practice medicine routinely on the basis of results of the latest clinical trials, expert opinions and guidelines. Clinical acumen based practice works well for majority of situations. This helps in not only providing timely care. But also keeps costs under control.

The Indian Scenario

In a country like India a general practitioner has to see as much as 100 patients in a day suffering from all kinds of ailments from head to toe. How do you expect him to keep himself informed about latest clinical trials, expert opinions and guidelines applicable individually to his patients? From where is he going to get the time for it?  Further, whether or not great majority of his patients have means to compensate efforts involved?

The Solution

This calls for an entirely different approach to practice of so called evidence based medicine. At the level of undergraduate medical education, undergraduates should be trained in information sciences.

This calls for  reorganizing medical education so that young medical graduates precisely understand information architecture and information management so that they are able to use vast repository of medical information for the purpose of optimized health care delivery in an affordable manner and practicing doctors are able to keep themselves updated with ever advancing medical sciences on case-to-case basis.

The above views are in response to the article http://cardiobrief.org/2011/04/17/evidence-the-weak-link-of-evidence-based-medicine/

Author: Varun Jain is a qualified engineer. He completed his B. tech in 2011 from Delhi College of Engineering. Thereafter he worked for Deloitte Consulting, Hyderabad. But within a short span he realized that a job is not something he is really interested in. He wanted to set out as an independent but innovative entrepreneur. He expressed his thoughts before his family and with due family support he launched http://curatio.in in September 2012 as an Online Healthcare Marketing Hub. http://www.linkedin.com/company/curatio-technologies?trk=hb_tab_compy_id_3001571

 

Image is about 150 listed fixed stars. Is it possible to scientifically explain 'Fixed Star'. Fixed stars are the basis of notion of rest/inertia in physics. North Pole Star or Dhruv Tara is cited as key evidence. But Fixed Stars are not really fixed. Fixed Star •Asterism •North Pole Star •Dhruv Tara •Inertia •Rest •Physics •Einstein •Newtonian Mechanics •Mach Postulate •Fixed Stars •Wandering Star

Can Fixed Star be Explained

Can Fixed Star be Explained

Summary

Existence of Fixed Stars was well known to ancient astronomers. Physicists have built the entire edifice of laws of physics upon notion of Fixed Stars despite the fact that the notion suffered a setback in 1718 with discovery of proper motion of Fixed Stars. However to explain the phenomena of Fixed Stars on the basis of known laws of science is just not possible and so the phenomena continues to be as mysterious as ever.

Fixed Stars

Night sky looks the same, viewed from any location on Earth.

Asterism

Stars form patterns known as Asterisms consisting of groups of two or more stars.  Member stars of an asterism bear constant spatial relationship to each other despite being physically unrelated. Asterisms further constitute defined areas of celestial sphere known as Constellations.

fixed star Can Fixed Star be Explained
Fixed star Vega, as photographed by the Spitzer Telescope

North Pole star Polaris is always aligned to North Pole of Earth and is used to determine latitude and longitude of a place in Northern hemisphere. Likewise South Pole star - Polaris Australis bears a constant spatial relationship to South Pole of earth. North Pole star despite bearing a constant spatial relationship to North Pole does not occur at a specific point in space, it rather occupies the spatial locus defined by precession cycle of Earth’s axis which takes place in a span of 25,772 years. During the cycle actual pole star keeps changing. For example presently, Polaris is the North Pole star but in 3000 CE, Gamma Cephei is expected to be North Pole star and in 5200CE Iota Cephei, will assume the title.

Motion of Fixed Stars

61 cygni proper motion fixed star Can Fixed Star be Explained
Proper Motion of Fixed Star

Ancient astronomers referred to all these stars as Fixed Stars, since they were unable to observe their motion in relation to a geographical locus. However in 1718 Edmund Halley announced his discovery that Fixed Stars are not fixed but have proper motion. The Fixed Star with largest known proper motion is Barnard’s star. Besides Fixed Stars ancient astronomers also defined wandering stars which were seen to move and change their position in the manner of Sun and Moon. They change their position within a band of stars known as Zodiac. Other than fixed stars is Wandering Star.

Fixed Stars and Theoretical Physics

Notion of Fixed Stars even though no longer valid has impacted physicists in a profound way. In fact foundations of Newtonian Mechanics and Einstein’s Relativistic Physics rest upon notion of Fixed Stars.

Newtonian Mechanics and Fixed Stars

In Newton’s time the fixed stars were invoked as a reference frame supposedly at rest relative to absolute space. In other reference frames either at rest with respect to the fixed stars or in uniform translation relative to these stars, Newton’s laws of motion were supposed to hold. In contrast, in frames accelerating with respect to the fixed stars, in particular frames rotating relative to the fixed stars, the laws of motion did not hold in their simplest form, but had to be supplemented by the addition of fictitious forces, for example, the Coriolis force and the centrifugal force. Einstein’s Relativistic Physics and Fixed Star In formulating Einstein’s Theory of Relativity, Einstein believed that inertial property of rigid bodies to move along straight lines in accordance with Newton’s first law of Mechanics was due to influence of fixed stars. This was also in accordance with Mach’s Principle which says “Local physical laws are determined by large scale structure of the universe”.

Contradiction between notion of Fixed Stars and Rest in Physics

But all the above discussion raises the question of demonstrable connection between Fixed Stars and rigid bodies on earth forcing them to move along a straight line until and unless acted upon by an external force. Unfortunately, no such connection has been demonstrated so far. Irony of the situation is that notion of fixed stars upon which rest the entire edifice of Newtonian Mechanics, EinsteiN’s theory of Relativity, Mach’s Principle etc. in itself was found to be incorrect as early as 1718 by Edmund Halley. So, laws of physics stand on a shaky foundation. Hence, there does not arise any question of laws of physics explaining star fixations. It is quite amazing that two or more celestial bodies apparently having independent motion, having no demonstrable physical connection maintain relative position to each other. Not only this, even actual celestial bodies change from time to time while keeping relative positions all the time. Presently, there are no known scientific laws that can explain the phenomena. Rather, scientists have been misled by the phenomena. Clearly nature is mysterious much beyond our imagination and presently it is not possible to explain all the known scientific facts on the basis of known natural laws.

Author

Dr Mahesh C. Jain is a practicing medical doctor and has written the book “Encounter of Science with Philosophy – A Synthetic View“. The book begins with first chapter devoted to scientifically valid concept of God and then explains cosmic phenomena right from origin of nature and universe up to origin of life and evolution of man. The book includes several chapters devoted to auxiliary concepts and social sciences as corollaries to the concept of God. This is the only book which deals with origin of nature and universe from null. Several chapters of the book are devoted to physics. Science of God