Vision and practice

Evidence-based patient choice and psychiatry
Tony Hope
2002
Evid Based Mental Health
http://ebmh.bmj.com/content/5/4/100.long

It's rare that vision becomes achieved.

"
1 THE ISSUE IS IMPORTANT TO PATIENTS MAKING CHOICES
2 THE EVIDENCE MUST BE OF GOOD QUALITY
3 INFORMATION SHOULD BE IN A FORM THAT IS ACCESSIBLE TO PATIENTS BUT
WITH MINIMUM BIAS
4 THE INFORMATION CAN BE USED BY PATIENTS TO ENHANCE CHOICE
"

And this splits into 4 stages
"
1 Giving information to patients within the consultation
2 Giving information to patients outside the consultation
3 Evidence-based medicine and guidelines
"

This doesn't happen in clinical practice in my personal experience.

A point about the use of evidence-based medicine in mental healthcare made by someone smarter than me

On evidence and evidence-based medicine: Lessons from the philosophy of science
Maya J. Goldenberg
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4HWXP4C-1&_user=10&_coverDate=06/30/2006&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7abaad1613f250879855c2a03fb539a6

The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920–1950). At the same time, the term “evidence-based medicine” has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how ‘evidence’ has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered.

The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause.

Research, impact on the media and distribution lists

This was published recently.

Acupuncture stimulates release of natural painkillers, researchers say
http://www.timesonline.co.uk/tol/news/science/medicine/article7140566.ece

The review of studies was published in 2008 then republished or corrected in 2009. It's recently been accepted into the NHS mental health evidence database. They email out the latest additions every month. There were lots of interesting papers. This was probably the lowest quality paper with the least amount of information in the DARE record from last month's crop of papers. But the media picked this one possibly because it's more interesting and topical after the recent libel law victory where Simon Singh successfully appealed against the British Chiropractors Association's case.

I picked a different paper to publicise. This is a much higher quality paper and another one I wish I could read. It's more rigorous but it's not interesting to the media.
http://www3.interscience.wiley.com/journal/122368525/abstract?CRETRY=1&SRETRY=0

The two DARE links are
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009107256 - the music therapy paper
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12010001083 - the acupuncture one

The most interesting recent publication on the list was the WHO's book, "Equity, social determinants and public health programmes", but it's 303 pages long. I'm sure it'll get some coverage.
http://www.library.nhs.uk/MENTALHEALTH/ViewResource.aspx?resID=374124&tabID=290

Vicious circle of social determinants and mental disorders

From the WHO publication Equity, social determinants and public health programmes
http://whqlibdoc.who.int/publications/2010/9789241563970_eng.pdf

How mad is this?

http://psychology.wikia.com/wiki/Schizotype

Or how mad am I? Or how normal?

Why do people change?

Do emotions help people to change? Does unhappiness or distress trigger
change and what is the interplay between pain as a result of change and
change as a consequence of pain?

A happy or content person doesn't look to change their life. A person
without desire has achieved nirvana and they need nothing. They have no
desires so they have no pain so they also don't change anything in thier
life.

Am I my conscious, subconscious or unconscious mind?

This isn't a question of any relevance to anyone who's still in the
single "I" represented by the stream of consciousness state of awareness.

Psychological theories like the parent-adult-child model or the whole
Freud thing use pedagogies, perhaps, to teach that there are many parts
to the individual and their mind. De La Soul have also attempted to
explain this with the lyrics, "it's just me, myself and I."

For a person who has the separated self state of awareness an observer
could consider the other consciousness to be the sub or unconscious
mind. My assumption is the "I" I consider myself would be represented by
the term "conscious mind."

What if that wasn't true? What if the expectations of the conscious mind
were not applicable to the "I" that was my sense of self or me. What I
mean is what if got it wrong about who "I" was in the "me, myself and I"
model of the mind and the stream of consciousness.