Which physician offices can PA's practice?

[cbrsmurf]

I thought they used PA's in UK, but I don't know.  You're old and bitter, so you're probably right :)

[EMEDPA]

I thought they used PA's in UK, but I don't know.  You're old and bitter, so you're probably right :)

ok, I guess dr watson could be an collaborating MD for a physician associate in England.

not that old, and not that bitter. getting mellower every day. amazing what quitting bad jobs can do for you....:)

[rev ronin]

The entire concept of EVIDENCE based medicine requires that one discount therapies that have not been studied and evaluated in the proper methodology for their effectiveness & safety.

 

Absence of evidence is not evidence of absence.  You've essentially lumped traditional Chinese medicine with homeopathy, when the two are nothing alike.  This drives the one PA-TCM practitioner I know nuts.

 

Evidence based medicine is what we strive for, but tell me.. why are there no pregnancy category 'A' drugs?  Because it would be unethical to intentionally experiment on pregnant women and their unborn children in a randomized controlled trial just to establish proof of non-harm, wouldn't it?  How, then is using pregnancy category 'B' drugs any different than TCM or acupuncture?  Both are essentially observational and based on cumulative anecdotes of help and lack of documented instances of harm.

 

A real evidence-based medicine approach recognizes that not everything is subject to a double-blind, placebo-controlled RCT, and recognizes that plenty of "high quality" medicine suffers from publication bias imposed by the studies' pharmaceutical company sponsors, that many studies prove unrepeatable, and that supposed medical breakthroughs have suffered from wholesale fabrication and fraud.

[treejay]

The entire concept of EVIDENCE based medicine requires that one discount therapies that have not been studied and evaluated in the proper methodology for their effectiveness & safety. You may not like how they're saying it, but really what they're saying is "there is no scientific evidence to support this claim/procedure/supplement".

 

And I think medical providers have to be careful not to be overly PC when addressing homeopathy, herbal tx, etc. Because some people will take the lack of a flat out rebuttal as a ringing endorsement of their use. And that can be detrimental to both pt safety and health.

 

 

^^^^ but what you fail to understand is how the gross majority of the major studies are funded:  by big pharma.  Big pharma has absolutely no incentive to study medicines/remedies/therapies that they cannot profit on.  If you believe that just because a potential therapy isn't valid because there isn't a study shows a lack of understanding of the broader context of what is studied and why it was chosen to be studied.  You cannot detach this from the economic incentives driving the whole system.  That would be considered native at best. 

 

We are speaking generally here.  Because that's are you can do without being specific.  There will always be exceptions.  But you need to understand the context and the bigger picture.

[treejay]

The entire concept of EVIDENCE based medicine requires that one discount therapies that have not been studied and evaluated in the proper methodology for their effectiveness & safety. You may not like how they're saying it, but really what they're saying is "there is no scientific evidence to support this claim/procedure/supplement".

 

And I think medical providers have to be careful not to be overly PC when addressing homeopathy, herbal tx, etc. Because some people will take the lack of a flat out rebuttal as a ringing endorsement of their use. And that can be detrimental to both pt safety and health.

 

 

The more I read you statement, the more I think you don't have any idea who is funding the major studies.  And to pretend for a second that who funds the studies has no bearing on what evidence is produced is a completely ludicrous

[treejay]

Absence of evidence is not evidence of absence.  You've essentially lumped traditional Chinese medicine with homeopathy, when the two are nothing alike.  This drives the one PA-TCM practitioner I know nuts.

 

Evidence based medicine is what we strive for, but tell me.. why are there no pregnancy category 'A' drugs?  Because it would be unethical to intentionally experiment on pregnant women and their unborn children in a randomized controlled trial just to establish proof of non-harm, wouldn't it?  How, then is using pregnancy category 'B' drugs any different than TCM or acupuncture?  Both are essentially observational and based on cumulative anecdotes of help and lack of documented instances of harm.

 

A real evidence-based medicine approach recognizes that not everything is subject to a double-blind, placebo-controlled RCT, and recognizes that plenty of "high quality" medicine suffers from publication bias imposed by the studies' pharmaceutical company sponsors, that many studies prove unrepeatable, and that supposed medical breakthroughs have suffered from wholesale fabrication and fraud.

^^^^ yes.. A more intelligent understanding of how studies are chosen and designed.  Not just blindly subscribing to EBM as the bees knees without limitations or bias.   

[PACdan]

^^^You can decry "big pharma" all you want as the evil empire. The fact is that they are making medicines that have to be vetted by a pretty extensive FDA approval process.

 

It's not the best system, but it's the best of what we have.

 

To make the claim that unproven, unregulated, and unstudied therapies (which doesn't just include medicines by the way; but also procedures and techniques) should be considered on equal footing with tested, studied therapies with statistical results is foolish.

 

I am being taught to practice medicine with an open mind. But that openness must also be rooted in the medicolegal basis of EBM and the community standards of care.

 

When we practice to those standards, we are doing the best by the patients with the breadth of current scientific knowledge and understanding that is held in the medical community.

 

[tunafish]

Suggestion that non-EBM supplement market is lacking funds is simply... not true. Just have read the article about anti-influenza "drugs" that are "approved" in several countries and even listed on essential formularies there. The combined revenue from them is in billions of $ and active ingredients include some isolated interferons or animal sera that is then diluted 1:100 50 times in a row. Basically one molecule of "active ingredient" per 100 tablets. This juju is on tv, in papers and in every doc's office. People trust because it comes from the "doctor's mouth"...

And let's not start about the claims that cosmetics companies make about wrinkles, induction of collagen expression, cell membrane repolarization. Yes, it looks good, smells very nice and feels good on the skin but there is NO EVIDENCE but they will be happy to sll it to you for $120 an ounce.