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• W2185975942 abstract "The essence of providing patient care revolves around the process of medical decision making (MDM). For most health care providers, this process flows smoothly from diagnosis to treatment planning. Practitioners typically become aware of this complex process only when questions arise. Occasionally, a health care provider will seek some secondary source of information, a book, a colleague, or a website to reach clarity. Only very occasionally, will the patient come into this inner sanctum of health care practitioners: treatment planning. It is hoped that all will routinely engage the patient in a discussion to arrive at informed consent, so that treatment may begin. This process of MDM is at the core of what makes up health care. In the last 20 years, evidence-based medicine (EBM) has made huge inroads into medical training in an effort to instill sound reasoning about efficacy and effectiveness in all medical graduates. In this article, the terms eff icacy (demonstration of benefit under ideal conditions, typically in randomized controlled trials [RCTs]) and effectiveness (demonstration of benefit in real-life conditions) are used very carefully, and not interchangeably. The value of efficacy lies mainly in its ability to indicate potential for effectiveness accurately. Sadly, in the drive to emphasize the importance of delineating clearly sound measures of clinical effectiveness, modern medicine has come to equate RCTs as the final arbitrators of clinical decision making. As discussed below, RCTs are but one tool to sort out these complex questions. In integrative medicine (IM), particularly, with its emphasis on patient variables and practitioner participation, evaluation of efficacy is not sufficient. For some time, IM has functioned like a stepchild to conventional care in MDM as the research base and number of large RCTs remains imbalanced. Almost all decision making based on the primacy of large RCTs creates a strong preference for the conventional care options, given the primacy of pharmaceutical funding, which drives the vast majority of large RCTs. In fact, overdependence on RCTs has been fostered by the need for conventional pharmaceuticals to meet Food and Drug Administration (FDA) requirements for marketing. Gradually, the influence of EBM has been misinterpreted to embrace RCTs as the only form of evidence considered to be valid. It is also important to note that some of the assumptions upon which RCTs gained favored status over observational data have now been shown to be without merit. 1 This article describes the process of MDM from the perspective of IM. First, the article reviews why RCTs are but one approach to sorting out the issue of efficacy and effectiveness. This article proposes an amended scale of effectiveness that includes alternative criteria. Second, the article examines why treatment benefit is but one of the two crucial questions that we need to ask about every treatment that we consider. Maizes et al. 2 and others in IM have argued that risk issues must be an increasing part of the discussion about treatments plans. This article proposes a scale for risk concerns aimed to create a needed dialectic process to balance every discussion of effectiveness. Finally, the importance of patient variables is discussed in the context of IM." @default.
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• W2185975942 date "2011-01-01" @default.
• W2185975942 modified "2023-09-22" @default.
• W2185975942 title "Medical Decision Making in Integrative Medicine" @default.
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