Sorry I cut off part of your post. There wasn’t enough room unless I did. But I think I preserved enough of it to express the gist of it.
You don’t think there is ENOUGH use being made of evidence-based medicine? I can tell you have not discussed this with experienced doctors who have real expertise, and highly recommend that you do so, if possible, in formulating your opinions. Physicians who know their stuff are entirely aware of what “evidence based medicine” dictates. For goodness sake, you can get the “answers” according to “evidence based medicine” on Google. They are also aware that the “tried and true” can be made into mechanistic formulas that do not allow for real thinking. A computer can do most of what “evidence based medicine” is.
“Evidence based medicine” is derived in two ways: First, it mechanistically follows FDA approvals. So that, for example, a drug that was initially approved for depression, but which physicians have found, or analyzed from a drug-interactive judgment, is helpful for, say fibromyalgia (and there absolutely are drugs like that) or for autistic episodes (and there are those too) cannot be used for those latter purposes under “evidence based medicine” until and unless the FDA changes its literature on the drug.
Second: “Evidence based medicine” is actually an invention of a medical center in the UK. it’s a formula devised to make the British medical system work more cheaply, having peer-reviewed and approved journal articles as its foundation. It can make the practice of medicine easier in a way, because a computer or a nurse trained to use a computer can do it. It is also geared to cost savings. So, for example, if a child is taken to a doctor with a severe earache. No question that the child has an ear infection. Most physicians or NPs would, in such a case, and using their own judgment, prescribe an antibiotic for that due to the hazard of permanent damage. “Evidence based medicine” however, dictates that the treatment be pain relief only, and a waiting week before further consideration of antibiotic use. There is no particular therapeutic reason for that, but it can save money. The downsides, of course, are that the child may sustain avoidable damage and that the antibiotic use could reveal a more serious situation, such as MRSA, by excluding less serious agents as the culprits.
“Evidence based medicine” dictates that back pain, even with radicular symptoms, be treated as a “strain/sprain” only, unless there is a clear connection to a traumatic event thought capable of producing physical damage beyond a strain/sprain. The “formula” says pain relief and muscle relaxants are the only treatments allowable at that point. A neurosurgeon, for example, who is not constrained by “evidence based medicine” and is confronted with back pain and radicular symptoms, is going to rely fundamentally on his clinical exam and gained expertise, and if he thinks the radicular symptoms indicate nerve root compression, with signs suggesting disc herniation or a free disc fragment he’s going to order an MRI, possibly a CT, and likely the very same day. If the radiograph confirms his clinical diagnosis of nerve root compression,particularly if he thinks there is any hazard of an oncoming cauda equina syndrome, he’s going to seriously consider a surgical resolution right away. And he isn’t going to base any part of his treatment on whether there was a traumatic injury or not, because you can blow a disc or get a bulge capable of producing spinal stenosis simply sneezing, tying your shoe or turning over in bed. The downside, of course, in following the “formula” mechanistically is running the risk of more serious consequences such as paraplegia.
That’s not to say that “formulary approaches” have no merit at all. But they can cause perverse results, and not infrequently do. They tend strongly to “institutional approaches” which can be manipulated by government if government is imposing them. And, of course, they tend to take physician judgment, and certainly intuitive judgment, out of the equation. Of course, if this country opts for socialized medicine like Britain’s, medical treatment is almost certain to become more formulary and mechanistic, for three reasons. First, socialized medicine is expensive and tends to encourage overutilization, placing greater burdens on the medical system. Second, bureaucracies just don’t trust individual judgment about much of anything, and naturally tend to formulary solutions to everything. Third, governmental decisions are more subject to political influence than is private medical judgment. Need to reduce the medical budget a little? Well, maybe that child’s earache could be ignored for two weeks instead of just one.
You can never be too careful, you know.