Needle in the Hay – A Reply to Dunning et al

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Dunning et al write that the “the purpose of this article is to directly respond to these claims in a public forum”, however after reading their reply it would seem their idea of directly responding to the claims in our article are to craft an argument from authority, attempt to demonstrate proof by verbosity, mischaracterize the points we made and to shift the goal posts away from the actual acupuncture data towards ad hominem attacks on our personal and professional credibility. We see no part of Dunning et al’s reply that adequately addresses the crux of our PT in Motion article — The fact that Dunning et al misrepresented the findings of the Manheimer (2010) and Vickers (2012) systematic reviews, which include many of the trials Dunning et al cite in their original article and their recent blog post. Continue reading

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Why Your Expertise Does (and Does Not) Matter

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In his book The Philosophy of Evidence Based Medicine, Jeremy Howick proposes a re-defining of Evidence Based Medicine from:

Evidence-based medicine requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances

to something that better clarifies the role of clinical expertise:

Evidence Based Medicine requires clinical expertise for producing and interpreting evidence, performing clinical skills, and integrating the best research evidence with patient values and circumstances. 

This new characterization is carefully crafted to highlight the essential functions of clinical expertise while simultaneously de-valuing its evidential role. Why is such a change necessary? Because clinical expertise in isolation is unreliable in its ability to infer the benefit or harm of an intervention. The uncontrolled observations that contribute to clinical expertise is rife with confounders such as placebo effects, natural history and hasty generalizations. This is problematic when clinical expertise is assigned a significant evidential role when adequate comparative clinical studies are available. Continue reading