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EDITOR'S CHOICE: Kamran Abbasi Dawn of the diagnostic age BMJ 2003; 327: 0-g [Full text]

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New era of evidence based practice and its limitations!

Waris Qidwai   (14 November 2003)

Dawn or Zenith of Clinical Diagnostic Age?

Sergio Stagnaro   (14 November 2003)

New era of evidence based practice and its limitations! 14 November 2003
Waris Qidwai, Associate Professor, Family medicine Aga khan University, Stadium Road,PO Box:3500, Karachi74800 Send response to journal: Re: New era of evidence based practice and its limitations!	One fully agrees with the author that evidence for diagnostic tests must be found and practiced. It is no longer appropriate nor desirable to carry on with screening tests that may not be valid.It is no longer considered adequate to treat a patient purely on clinical experience alone, without a clear demonstration of evidence based on research(1,2) An examination of the "evidence-based practice", shows that it has usually been filtered through the opinions of experts and journal editors, and "Opinion-Based Medicine" would be a more appropriate term(3)Evidence for the best medical practice is often not available, limiting the practice of those who support it(3) As a result there are calls to revise the "Evidence Based Medical practice model", wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour(4) Despite all the available evidence,its application in a given case will continue to be a function of human mind.There may still be room for diagnostic tests for which strong evidence may not be available today, since in practice and in conjuction with other available practice tools, it may still be of benefit to the patient! References 1. Wallach PM, Roscoe L, Bowden R. The profession of medicine: an integrated approach to basic principles. Acad Med. 2002; 77:1168-9. 2. Atiya AS. Teaching of evidence-based medicine to medical undergraduates. Med J Malaysia. 2002;57 Suppl E:105-8. 3. Hampton JR. Evidence-based medicine, opinion-based medicine, and real- world medicine. Perspect Biol Med. 2002;45:549-68. 4. Tracy S, Dantas GC, Upshur RE. Evidence-based medicine in primary care: a qualitative study of Canadian family physicians. BMC Fam Pract. 2003 Competing interests: None declared
Dawn or Zenith of Clinical Diagnostic Age? 14 November 2003
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8. 16037 Riva Trigoso (Genoa) Italy. Send response to journal: Re: Dawn or Zenith of Clinical Diagnostic Age?	Sir, As founder of Biophysical Semeiotics (See HONCode web site ID 233736, www.semeioticabiofisica.it), I am, to some extent, delighted with reading Kamran Abbasi’s Editor’s choice (1), as well as other exciting papers in this issue of our journal on the dawn of the diagnostic age. Unfortunately, however, I must recognize in all published articles that my dear colleagues, around the world, are speaking only about EBM, and not also of SPBM, i.e., Single Patient Based Medicine (3) (See above-cited site), clearly overlooking the new physical semeiotics. As depression diagnosis is concerned, e.g., you are kindly invited to read my previous paper on a reliable biophysical-semeiotic method, easy and quick to perform at the bed side in a few minutes, useful in diagnosing depression in a "quantitative" manner(2). Doctor, doing that, utilize plainly new paradigms in diagnostic procedures, the new physical semeitotics is based on. It seems obvious that some of what we now take for granted will quickly become outdated as new ways appear, as in the field of the bed side diagnostics. For example, the existence of Oncological Terrain (4), described even in above-cited web site at URL http://www.semeioticabiofisica.it/semeioticabiofisica/oncological.htm: without oncological predisposition, easy to evaluate clinically in a “quantitative” way, as the real risk of malignancy in well defined tissue is concerned, cancer does not occur at all, facilitating, therefore, both diagnostic procedures and primary prevention. This is the reason that one may speak of the zenith, rather than the dawn, of “clinical” diagnostic age. 1) Kamran Abbasi. Dawn of the diagnostic age. BMJ 2003;327 (15 November), doi:10.1136/bmj.327.7424.0-g 2) Sergio Stagnaro “Single Patient Based Medicine” versus EBM. (16 May 2003) http://bmj.com/cgi/eletters/326/7398/1048#32299 3) Stagnaro S. Depression, Anxiety and Psychosis. B C Medical Journal 2001, Volume 43, Number 6, page 321, July-August. 4) Stagnaro S. Il Terreno Oncologico. Contributo della Semeiotica Biofisica alla Prevenzione Primaria dei Tumori. (in press). Competing interests: None declared