User:Pierre-Alain Gouanvic

From age 26 to 31, I ingested gigabytes of information in neurology, metabolism, endocrinology, clinical nutrition, physiotherapy and… metabolic diseases. A reputed medical doctor specialized in metabolic diseases, who had received the Albert Schweitzer prize, said about me that I had "plausible and testable hypotheses", that I was working on valid questions in the field of neurology, and that my tenacious work and my intuitions should be appreciated. I will not explain in details the reason of this interest in metabolism, etc., as it is personal, nor will I explain why I was told by another respected researcher that I had "an enormous intuition".

I am completing a degree in translation (Concordia University; English to French) and building a Web site designed to welcome and offer shelter to persons who want to become "expert patients". I am focussing on the right to health as a right to information regarding health, in accordance with the Covenant on Social, Economic and Cultural rights of the United Nations. In doing so, I hope to promote the idea that citizens, when faced with the problem of their physical integrity, are able and willing to become responsible and knowledgeable citizens in matters related to their biology, taken in its widest sense.

I have worked as a terminologist (scientific and technical terminology) and received very favourable evaluations from experts in the field. However, even if I am not receiving a salary for it, I prefer giving time and passion to the Right to health Website and to Citizendium, and focus, for basic life-sustenance, on other activities such as freelance translation and community work in the field of Human rights. I am married and I am the father of two adorable children.

Tools

To create references in Wiki format using PMIDs

OAIster Open Access Index search

Contact

Email: pierre.alain.gouanvic@gmail.com

Website

Observatoire du droit à la santé

English version (Right to Health Watch) coming soon.

Questions on my mind

• In the evaluation of non-profitable medical interventions, are we talking of evidence-based medicine or absence-of-RCT-evidence-based medicine?
  • Evidence-Based Medicine - watching out for its friends Excellent overview of the real state of affairs with EBM
  • Ethics and evidence based medicine:

Deciding between competing claims

The second philosophical criticism, that it may be impossible to decide between competing claims of different stakeholders, is emphasised by the manner in which patients continue to have little influence over the priorities of research. Evidence based medicine claims to reject the power of expert opinion but it is still mostly doctors who determine research objectives, who interpret research data, and who implement research findings. A number of commentators have called for greater involvement by consumer groups in setting research agendas, but how conflicts between the agendas of the different stakeholders are to be resolved remains unclear. 10 11 Evidence based medicine is unable to address political concerns because the values of different stakeholders, and hence the way in which they interpret evidence, cannot always be made congruent with each other.

Systematic bias

Governments and health funds find the notion of allocating health resources on the basis of evidence attractive.26 Eddy has suggested that healthcare funds should be required to cover interventions only if there is sufficient evidence that they can be expected to produce their intended effects.27 The Australian health minister, Dr Michael Wooldridge, who is a strong supporter of evidence based medicine, has adopted a similar position, stating "[we will] pay only for those operations, drugs and treatments that according to available evidence are proved to work."26

Given the complexities of the issues surrounding resource allocation, the drive to seek certainty and simplicity at the policy level is understandable. However, the large quantities of trial data required to meet the standards of evidence based medicine are available for relatively few interventions. Evidence based medicine may therefore introduce a systematic bias, resulting in allocation of resources to those treatments for which there is rigorous evidence of effectiveness, or towards those for which there are funds available to show effectiveness (such as new pharmaceutical agents). This may be at the expense of other areas where rigorous evidence does not currently exist or is not attainable (such as palliative care services). Allocating resources on the basis of evidence may therefore involve implicit value judgments, and it may only be a short step from the notion that a therapy is "without substantial evidence" to it being thought to be "without substantial value."8

(...)

Simplistic solutions

According to Williams, "there is great pressure for research into techniques to make larger ranges of social value commensurable. Some of the effort should rather be devoted to learning---or learning again---how to think intelligently about conflicts of values which are incommensurable."9 This is particularly the case where it comes to making decisions about allocation of health resources. Those charged with making these decisions are seeking simplistic solutions to inherently complex problems---the danger is that through evidence based medicine we will supply them.

• IOW: Is there a lack of evidence-based medicine or an excess of lack-of-evidence-based medicine?
• Is objectivity a bias in a world where EBM creates clinical opinions?
• What will happen of the so-called anecdotal reports when everything will be assumed to be known from large-scale clinical trials?
  • Original research in pathology: judgment, or evidence-based medicine?
• Does the "invisible hand of market" take good care of science when deciding what trials will be funded?
  • Non-financial conflicts of interest are more serious than financial conflicts
  • Ethical problems arising in evidence based complementary and alternative medicine RESEARCH FUNDS ARE SCARCE

Funds are scarce for CAM research compared with most areas of medical research.21 Governments and other funding bodies usually allocate health resources on the basis of existing evidence.22 Because the evidence for CAM is fragmentary and evolving, research applications in CAM—other than to government agencies specifically created to fund CAM research, such as the (rather unique) National Center for Complementary and Alternative Medicine (NCCAM) at the NIH in the US—have a lower chance of receiving funding than those in conventional medicine. This situation creates a systemic bias, which results in allocation of resources to those areas of (conventional) medicine for which reasonably good evidence already exists. The resulting funding stream is at the expense of areas in which no or less evidence currently exists—for example, CAM.23 This impinges on the ethical principle of justice. In principle, it also perpetuates the under researched status of CAM.

• Desired Attributes of Evidence Assessments for Evidence-based Practices
• Why are stages of moral development not regularly assessed? (Kohlberg scale, others)
  • Generosity 'may be in the genes'
• Where's Superman?

TO DO LIST

Not an inclusive list!

Doctors

• Kousmine
• Klenner
• Cathcart
• ....

Conditions

• Stroke
  • Stroke rehab (huge topic)
• CHD vs n-3 FAs (indicate the errors in the Cochrane review)
• MCS (description); cf recent research by Rae

Molecules

• Vit C: see its talk page; transport; neurological role
• Mg
• Vit. D
• Carnitine
• ..

Topics

• EBM : recent special edition in the JECP