If there is any EBM for anything in stroke it is completely hidden from the public so we as survivors can't criticize the lack of protocols. EBM is precisely what our fucking failures of stroke associations should be doing but don't because press releases are obviously more important than solving all of the problems in stroke. I'm sure our stroke medical professionals will use this reasoning to not do anything in stroke because; 'All strokes are different, all stroke recoveries are different.'
If you ever hear this statement, scream bloody hell because that person has not been using their brain correctly when thinking about stroke.
Of course the main problem with EBM for stroke right now is that there is none so with nothing to follow it seems that stroke survivors have no need to be treated at all.
Wouldn't only 10% full recovery be considered malpractice on its face or 12% full tPA efficacy?
What the hell is it going to take for the stroke world to face up to their failures? Charging $1,000 for every neuron lost? That would be 1.9 billion a minute. That might focus the mind on getting tPA delivered in the ambulance with an objective diagnosis(no neurologist needed).
http://www.prnewswire.com/news-releases/evidence-based-medicine-compared-with-prussian-enlightened-absolutism-in-journal-of-american-physicians-and-surgeons-300142263.html
"Evidence-based medicine" has been elevated to the status of an obligatory "gold standard" of medical care. Physicians who deviate from the EBM "standard of care" are likely to be marginalized and face malpractice liability or even the ruin of their careers. In the fall issue of the Journal of American Physicians and Surgeons, Hermann W. Børg, M.D., draws some historic parallels to medicine in Prussia at the time of the Enlightenment.
"There
are striking similarities between the culture of the early
Enlightenment and today's post-modern digital revolution," he writes.
There was rapid change, with empowerment of new groups, as knowledge
became more widely available. This threatened the existing power
structure. Outright suppression by force backfired. So the political
aristocracy outwardly seemed to embrace the new ideas while covertly
sabotaging and subverting them.
The
Prussian model shows most clearly the effects of injecting political
power into medical practice, Børg explains. The Prussian system
conferred the title Geheim Rath (secret or confidential counsel)
on persons of recognized professional achievement, who had great
influence both inside and outside academia.
"The
main stated objectives were to improve the quality, effectiveness, and
affordability of medical care throughout the kingdom," Børg writes—just
like today. "This was supposed to be done by elimination of
'nonscientific' treatment methods through leveraging the expertise of
accomplished physicians."
The
guiding principle of EBM is also the old Prussian principle of "one
elegant formula can solve all the problems," Børg states. Enlightenment
theorists could not understand why medicine did not achieve spectacular
advances like those in industry and agriculture. "Perhaps the idea that
treating patients cannot be compared to making machines or farming did
not occur to them," he suggests.
Instead of improving medical care, the Geheim Rath
system caused chaos, fostered corruption and exploitation of young
physicians, and promptly became fossilized and interfered with any
innovations, especially those contradicting government dogma, he states.
Despite
its claims to be totally "objective," EBM generates guidelines through
consensus of chosen experts, each of whom has subjective biases. But
consensus is the basis of politics, not science, Børg points out.
The two outwardly different schemes have many common denominators, he notes. In both the Geheim Rath
system and EBM, the decision-making process is being out-sourced. It is
removed from the individual patient-physician interaction.
The results for medicine are likely to be similar, he concludes.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
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