Evidence from samples of one

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1052
  1. Astier M Almedom, medical anthropologist (
  1. Tufts University, Boston, Massachusetts

    Personal accounts of medical ordeals make illuminating contributions to the published literature on evidence. Left undocumented, the triumphs over cancer of Susan Sontag (Illness as Metaphor) and Michael Gearin-Tosh (Living Proof), the late Alice Trillin's battles with the aftermath of treatment for lung cancer (N Engl J Med 1981;304: 699), and Lenore Manderson's account of a sudden onset of brachial plexopathy (Internal Medicine Journal 2002;32: 353) might have been classified as “anecdotal evidence,” for which evidence based medicine has little or no place. Some doctors do, however, use evidence from single case studies, gaining understanding of medical phenomena encountered in their social and ecological contexts.

    The following brief summary of an ongoing longitudinal observation study of childhood idiopathic thrombocytopenic purpura (ITP) aims to contribute to this body of literature. Although case specific by nature, certain principles pertaining to medical decision making processes are likely to be transferable. The subject of this case study happens to be my first born child, who had the …

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