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by rz2k
4860 days ago
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I was overly subtle, because that was my point. As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment. Those on the ground with patients are very careful, and also figure out how to manage incomplete information pretty well. You may especially have missed my points that tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too. I don't know if anyone knows why we need these organs, yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason. |
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> As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment.
As an engineer and stats person, I find blind acceptance of "evidence based" medicine astonishing. The idea is robust and noble, but the execution is beyond horrible - to the point that it ISN'T clearly better than the alternatives. (It's practically impossible to compare false-negative=wrongly-rejected-treatment vs. false-positive=wrongly-accepted-treatment of today's EBM; but if the now-known-false-positives are any indication, we're in really bad shape).
> tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too.
That's only true if you compare to 1940-1980. If you assume they are needed, both are still removed with alarming frequency.
> I don't know if anyone knows why we need these organs,
The functions of both are known. Tonsils are an "early warning" outpost of the immune system - they sample pathogens while still in the throat, to give a "heads up" to the immune system in the gut. Removal of tonsils is associated with higher all cause mortality (especially heart attacks). The appendix is a curated cache of the good bacteria that the body needs in the gut (and possibly in other places), and there are circumstances in which the body will release another dose of good bacteria (though those are not well characterized yet, to the best of my knowledge).
> yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason.
I don't think that's really true. For one, most physicians in the US are still antibiotics-trigger happy (for whatever reason, even though most of them surely know it's harmful). That removes symbiotic organisms much more efficiently than it does harmful organisms, causing such things as yeast infections, the low B12 epidemic, and more.
They are more careful now with surgically removing stuff, true, but only recently, and only just.