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Anecdotal evidence.

What is that?  Observations made in clinical practice that do not provide definitive proof but may support rationale (that's the super dorky definition)  In simple terms, this is when a physician notices changes in a patient's condition through a form of treatment that has NOT been fully illustrated in research.  



Anecdotal evidence is what defines certain aspects of healthcare.  Let's face it, science is fantastic!  BUT, there are a lot of patients that have benefitted from treatments even though the exact mechanism of action (MOA) is unknown.  I include myself in the category of very scientifically-minded clinicians.  However, not every single treatment I perform has definitive proof or an exact MOA.  From the perspective of your family physician, not every medication they can prescribe offers definitive proof or an exact MOA.  We are all in the same boat.....

Let's look at gabapentin (commonly known as Neurontin).  This is a drug that was originally used to treat epilepsy and neuropathic pain.  It's chemical structure is similar to GABA, an important neurotransmitter.  Unfortunately, we do not know exactly how gabapentin effects epilepsy and neuropathic pain (although, there are theories).  The MOA is somewhat understood.

Now let's look at chiropractic manipulations (sometimes known as CMT).  This is a treatment originally used to treat neck and low back pain.  It's physiologic effect on the body involves the movement of certain joints and local tissue effects, like reduced pain.  Unfortunately, we do not know exactly how manipulations cause local and/or global effects in the body (although, there are theories).  Again, the MOA is somewhat understood.

Hopefully you recognize the similarities.  So, what is the point of this blog post then?

There are clinicians that prescribe medications (some of which the MOA may not be fully known) and clinicians, like myself, that perform treatments (again, some of which the MOA may not be fully known).  

 I am not trying to defend anecdotal evidence as superior to clinical research.  There should simply be a place for anecdotal evidence in daily practice; as clinicians (regardless of specialty) we all need to recognize the importance of anecdotes.  

IF we all agree that healthcare should be based in science, why are there discrepancies between professions?  Ultimately, healthcare should be about providing care to patients. What I am trying to say is that there needs to be a give-and-take when it comes to anecdotal evidence.  Medical professionals, ALL of us, should stay grounded in science without ignoring observations made in clinical practice that could benefit patients.

Isn't that what you want your doctor doing?


Be Blessed!
-Anatomy Geek

 


Comments

Frank
07/08/2015 6:17pm

I'm using Gabapentin for pain from Shingles. It makes me very sleepy. I'm not sure how much it helps the shingles pain.

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    Erik Korzen DC is a chiropractic physician and educator.  He is passionate about re-defining the chiropractic profession and is somewhat of an "Anatomy Geek".

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