The science fo spit testing and toilet training

The Case for Evidence-Based Toilet Training
Edward R. Christophersen
Arch Pediatr Adolesc Med 2003;157 1153-1154
http://archpedi.ama-assn.org/cgi/content/full/157/12/1153?etoc

Commenting on the title (I'm not an AMA member and the abstract was not available on Medline) this is hilarious. I think there is a tendency for us skeptics to insist on documented studies that demonstrate reliable consequences before we label any intervention as worthwhile. While we can insist our practice of medicine be evidence based, there has to be room for action, intervention, and decision that is based on common sense and expert opinion. The wisdom is in knowing when we can apply "common sense" and when we should be insisting on better study outcomes. Especially when inaction results in discomfort and soiled linen.

It is unfortunate that our post modernistic attitudes today do insist that anyone's opinion is considered equally expert. My point, however, was that skeptics who get hung up over the best way to potty-train, should not forget that the child should be trained, particulars of technique put aside. The same way a good skeptic would not take any randomized placebo controlled cross-over clinical trial as credible without first putting the methods and implications in context, the good skeptic would not expect this kind of study before approaching the task of potty-training.

In context, it's already understood that in our society, the vast majority of children potty-train successfully with no apparent direct negative results regardless of the method used. Unless some new information changes this understanding, there may be no scientific appeal for intensive clinical study.

Comment to the speculative reply of the Spit testing advocate:

I think my main point was about using wisdom in deciding what influences our actions. Skeptics who get hung up over the best way to potty-train, should not forget that the child needs to be trained, particulars of technique put aside.

Right on topic was an awesome article with a related point of view linked by a fellow HF list-member.

http://www.betterhumans.com/Features/Columns/Change_Surfing/column.aspx?ArticleID=2003-12-08-4&sendToAFriendID=2003-12-08-11

Beyond Doctors. Computers, capitalism and nurses are bringing us higher quality medicine By James Hughes

12/8/2003

There should be a wise place for acceptance of any medical intervention that is between the "holy grail" and anecdote. The elusive wisdom is finding that place for any given technology. I'd like to suggest that in most cases it can't be determined by the individual, who will be prone to bias based on their personal realm of knowledge and experience. The cardiac surgeon will insist on coronary bypass, the invasive radiologist will likewise insist on coronary brachytherapy. Consensus of understanding seems to be the way of learning and science.

In your HRT case, Dr. Lee (creator of this spit test) may be 100% on target, but when I followed Internet links for the applications of the theories he is promoting I found what appeared to be quick-buck health scams that all but suggest we all need testing and we all need supplements for things that may or may not be ailing us. Science theory all aside, my "wisdom" tells me I want to see health outcomes and know that my apparently significant long-term monetary sacrifice will likely guarantee a better, or less sick life.

As noble as Dr. Lee's intent is, his ideas are apparently being applied rather dubiously to sell tests and supplements. HMO's are about paying for health care, with finite resources. They are about money. Their wisdom tells them there could be a financial impact on claims should they begin to reimburse a new kind of testing or related HRT services. The mail-order testing company is about money, and the HRT supplement company is about money. Their wisdom tells them that if the HMO pays for this, they become multi-billionaires. Money drives the industry. The only neutral party becomes the body of scientific evidence and it's practical application. The wisdom for requiring either anecdotes or "holy grails" before accepting a technology is perhaps not often and never solely; but, rightfully influenced by the amount of money that could potentially be involved.

Another influence on the degree of evidence required for acceptance of a new technology, in no specific order, is the apparent degree from which the new technology goes against current standards of care. This may have very little to do with evidence based medicine in the beginning. For example, there is much practiced in medicine that has very little backing by clinical studies and scientific literature. But, it's been practiced without a hitch for several years and seems to offer predictable outcomes. When the next latest-greatest comes in to replace the standard, only clinical evidence may off-set the tendency to say "why fix something that doesn't appear to be broken?" or "why change something that appears to always have had acceptable predictable outcomes?"

Current protocols for HRT, although recently rather dynamic in their application, are very accepted standards of care. A revolutionary approach to hormone therapy is, I think, going to require a body of research before today's medical society accepts it. It has been said that for every genius that is crying in the wilderness there are a hundred charlatans. Those who label Dr. Lee may be just playing the odds. If Dr. Lee's ideas are indeed 100% correct, evidence based medicine and the scientific process is the medium by which this will come to light and be accepted in western medicine practice.

I disagree that EBM is about black and white. Practicing medicine is an art, and therefore subjective. An offered medical treatment is seldom presented as the right treatment, but rather the best treatment. Out of necessity, things in medicine often become absolute. Your HMO either will, or will not pay for saliva testing. EBM's goal is termed "best practice" and best is defined by wise analysis of scientific evidence.

P.S. in proofreading I can addend a couple of things. When I say that "money drives the industry" I do not imply that "greed" drives the industry. Also, akin, or even preferable to the estrodial patch, the woman now has the options of beads or the "Femring."