Saturday, January 30, 2016

Guest Blogger Dr. Mark Komrad on Evidence-Based Medicine and Clinician Experience

In my last post- Medications, Parrots, and Crazy Virginia Laws --, I talked about Robert Whitaker's post on Pete Earley's page.  I put a link to Pete Earley's blog, but not my Shrink Rap post, up on my personal Facebook page.  Now some of my Facebook friends are psychiatrists, so this turned my Facebook page into something of a blog post, with no cute animals.  You followed all that, right? (It's some weird version of social media hell, and yes, I tweeted it as well).  The commenters there gave me permission to put their responses as comments on Shrink Rap, but Dr. Mark Komrad's response exceeded the character count for a blog comment, so I'm giving him a guest post slot here.  Dr. Komrad is the author of You Need Help! an excellent book on how to get a loved one into treatment. His response is below:


Unknown said...

There is a major danger in trusting "personal experience" too much.

If it's the best you have to go on then sure, but if it contradicts large well run clinical trials then you might want to sit down and have a long hard think about it.

Talk to a homeopath, talk to [relative] who believes that magnetic bracelets are a cure-all, people who believe that vaccines cause autism, talk to people who believe in pretty much any pile of crap and their primary reason for believing what they believe will almost always be "personal experience".

They gave that person homeopathic pills before their cancer went into spontaneous remission, they started wearing the bracelet and their health problems went away, their nephew got his vaccine shots before starting school and was diagnosed with autism a few months later.

It's always personal experience and they'll throw the results of large clinical trials in the bin and instead believe in magic at a moments notice.

If you're trusting your own experiences and intuitions over the results of large well run trials then there's a small chance you may be right but the odds are that you're engaging in the same kind of thinking as the homeopaths, the anti-vaxers and the magnetic charm people.

Mark Komrad MD said...

I agree that "trusting too much" on personal experience is inadvisable. The art of clinical medicine is a dialectic between clinical experience and science (both basic and clinical research). As one of the venerated "father's" of American Medicine (and venerated historical figure at Johns Hopkins where Dinah and I trained) famously said : "If it were not for the great variability among individuals , Medicine would be a science not an art". This is why people seek seasoned practitioners for treatment or second opinions rather than always going to the newly minted physician who, in general, is much fresher and more stocked-up on the latest scientific studies acquired in prodigious abundance during recent residency training.