The Inclusiveness of Modern Medicine

Western Medicine has been branded non-inclusive, even close-minded. In many respects it deserves this designation. After all, medical guidelines have been constructed on dogma derived almost solely from “outcome trials”. Such trials are uniformly difficult to perform and have inherent constraints such as limited applicability to the specific patients we all see every day in practice. At times doctors do rely too heavily on guidelines and by so doing limit their own ability to think outside the box. Interestingly, doctors often utilize techniques and procedures in an “off label” fashion, meaning they are being used in ways for which they have not been approved, but they do so to benefit their patients. Still, most doctors fail to acknowledge the pervasiveness of “off label” practices and this self-blinding permits frequent condemnation of alternative or complementary strategies. For example, for years doctors have condemned chelation as pure quackery. Recently (TACT), a large clinical trial presented at both the American Heart Association (AHA) and American College of Cardiology (ACC) meetings, showed clinical benefit of this purportedly charlatan-based procedure. Another recent study noted that osteopathic maneuvers (also deemed useless by many western-minded physicians) appear to have real value. The long-awaited revised cholesterol guidelines are still in the process of being approved (this has been going on for many years). The hold-up – difficulty in creating guidelines based solely on high-level evidence. Translation; we recognize that we simply don’t know as much as we think, and sometimes pretend, to know.

So why, you may ask, is my title so optimistic? It’s because the winds of change are upon us. The subtle acceptance of methods such as chelation and osteopathy along with our guideline-related struggle to come to terms with our lack of knowledge speak volumes. We are coming to the point I believe, when we will be able to accept our imperfection. We will acknowledge the unique and permanent blend of art and science that is medicine. We will embrace our science-based creativity. By doing all this, we will enter a new, better, and more inclusive stage in the evolution of modern medicine.

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  1. Thomas Dayspring MD March 25, 2013 at 10:31 am #

    Fantastic piece by Dr Baum – What is slowly being lost in our academically driven “taken to the extreme, evidenced based medicine environment” is the “art of practicing medicine.” It is when a doc can say to a patient – we really do not know, but based on current knowledge and my clinical insight and experience: here are our diagnostic and therapeutic options! The real danger in all of this evidence based BS is that third party payers use them as a way to deny care!. Even more laughable is that the “EVIDENCED-BASED” medicine the proponets always quote are anything but. The “evidence” usually comes from clinical trials looking at narrow endpoints, under rigid conditions, in specific groups of patients with specific risks and thus in no way can they uniformly apply to the average patient seen in private practice who does not meet those criteria.

    • Seth Baum March 25, 2013 at 2:47 pm #

      Thank you Tom. I greatly appreciate your feedback. Because of doctor/educators like you, more physicians have been empowered to bring the art/science of medicine back into their medical practices. We are all grateful for your excellent work.

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