Dawn of the diagnostic age
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7424.0-g (Published 13 November 2003) Cite this as: BMJ 2003;327:0-g
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One fully agrees with the author that evidence for diagnostic tests
must be found and practiced. It is no longer appropriate nor desirable to
carry on with screening tests that may not be valid.It is no longer
considered adequate to treat a patient purely on clinical experience
alone, without a clear demonstration of evidence based on research(1,2)
An examination of the "evidence-based practice", shows that it has usually
been filtered through the opinions of experts and journal editors, and
"Opinion-Based Medicine" would be a more appropriate term(3)Evidence for
the best medical practice is often not available, limiting the practice of
those who support it(3)
As a result there are calls to revise the "Evidence Based Medical practice
model", wherein greater emphasis is placed on clinical expertise and
patient preferences, both of which remain powerful influences on physician
behaviour(4)
Despite all the available evidence,its application in a given case will
continue to be a function of human mind.There may still be room for
diagnostic tests for which strong evidence may not be available today,
since in practice and in conjuction with other available practice tools,
it may still be of benefit to the patient!
References
1. Wallach PM, Roscoe L, Bowden R. The profession of medicine: an
integrated approach to basic principles. Acad Med. 2002; 77:1168-9.
2. Atiya AS. Teaching of evidence-based medicine to medical
undergraduates.
Med J Malaysia. 2002;57 Suppl E:105-8.
3. Hampton JR. Evidence-based medicine, opinion-based medicine, and real-
world medicine. Perspect Biol Med. 2002;45:549-68.
4. Tracy S, Dantas GC, Upshur RE. Evidence-based medicine in primary care:
a qualitative study of Canadian family physicians. BMC Fam Pract. 2003
Competing interests:
None declared
Competing interests: No competing interests
Dawn or Zenith of Clinical Diagnostic Age?
Sir,
As founder of Biophysical Semeiotics (See HONCode web site ID 233736,
www.semeioticabiofisica.it), I am, to some extent, delighted with reading
Kamran Abbasi’s Editor’s choice (1), as well as other exciting papers in this
issue of our journal on the dawn of the diagnostic age. Unfortunately,
however, I must recognize in all published articles that my dear
colleagues, around the world, are speaking only about EBM, and not also of
SPBM, i.e., Single Patient Based Medicine (3) (See above-cited site),
clearly overlooking the new physical semeiotics.
As depression diagnosis
is concerned, e.g., you are kindly invited to read my previous paper on a
reliable biophysical-semeiotic method, easy and quick to perform at the
bed side in a few minutes, useful in diagnosing depression in a
"quantitative" manner(2). Doctor, doing that, utilize plainly new
paradigms in diagnostic procedures, the new physical semeitotics is based
on. It seems obvious that some of what we now take for granted will
quickly become outdated as new ways appear, as in the field of the bed
side diagnostics. For example, the existence of Oncological Terrain (4),
described even in above-cited web site at URL
http://www.semeioticabiofisica.it/semeioticabiofisica/oncological.htm:
without oncological predisposition, easy to evaluate clinically in a
“quantitative” way, as the real risk of malignancy in well defined tissue
is concerned, cancer does not occur at all, facilitating, therefore, both
diagnostic procedures and primary prevention. This is the reason that one
may speak of the zenith, rather than the dawn, of “clinical” diagnostic
age.
1) Kamran Abbasi. Dawn of the diagnostic age. BMJ 2003;327 (15
November), doi:10.1136/bmj.327.7424.0-g
2) Sergio Stagnaro “Single Patient Based Medicine” versus EBM. (16 May
2003) http://bmj.com/cgi/eletters/326/7398/1048#32299
3) Stagnaro S. Depression, Anxiety and Psychosis. B C Medical Journal
2001, Volume 43, Number 6, page 321, July-August.
4) Stagnaro S. Il Terreno Oncologico. Contributo della Semeiotica
Biofisica alla Prevenzione Primaria dei Tumori. (in press).
Competing interests:
None declared
Competing interests: No competing interests