Sigh. Gingernut off again on his antitherapeutic hobbyhorse.
Lets try and get a few things straight.
"In the old days, we relied on what "experts" thought would work...."
The days of "I think it works" ended at least in the fifties. Since then scientific studies have been expected to show statistical significance in order to be accepted. Ol' Ginge is still hanging on.
"...we really need robust evidence before we can subject our patients (and the people paying for health care), to unproven treatment." is hardly new!
Note the use of parentheses for "experts". Ginge doesn't believe in "experts" - there are no "experts", even if they are multiply qualified specialists of many years experience. Evidently I'm not an expert, only an "expert" whose abilities and motives are not to be trusted. Remember that when you fly, your pilot is not an expert, only a soi-disant "expert" who is quite probably incompetent.
Medical tree-huggers like Ginge keep harping on about "evidence based medicine" as though it was something absolutely new that they had discovered. Of course it isn't - strict statistical evaluation of therapeutic manoeuvres has been around since before Ginge was born, though admittedly it hasn't always been applied.
The interesting thing is that the current evidence for the benefits of "evidence based medicine" is rather poor - empirical treatment by experts (OK, "experts") actually seems to do no worse and frequently better.
"Evidence based medicine" is a bureaucratic and construct rather than a scientific one and is designed more to save money than to optimise anyone's health.
But
"revenons a nos moutons" as they say (or rather ears).
Otitis media is common in children and treatment is controversial. Allow me to quote:
"Because of a tradition of inappropriate prescribing of antibiotics for viral acute otitis media, their use has recently been condemned by many primary care practitioners for most cases of acute otitis media. Ear specialists tend to disagree with this philosophy and promote efforts to distinguish between viral and bacterial infection, so as to optimize treatment results by giving antibiotics only for bacterial infection. Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications. On the other hand, it is generally agreed that acute otitis media that is purely viral will usually resolve without antibiotic treatment, although associated persistent middle ear effusions may require medical intervention"
Similarly, while the efficacy of grommets in the treatment of chronic secretory otitis media is undisputed, there is no doubt that too many grommets are inserted for rather nebulous reasons (pressure from parents and money for a start).
Probably the majority of cases of chronic secretory otitis media will eventually resolve as the child gets older and a case can certainly be made for waiting. The downside is that prolonged deafness in children may delay speech, communication may be difficult and education may suffer - behavioural disturbances may occur. Whether these are worth suffering in the defence of therapeutic correctitude is a matter for debate (except for the gingernuts of this world).
"....we refer less and less patients for useless, or dangerous operative procedures...."
This is an interesting statement.
Basically your GP knows best and that "experts" (like trained ENT specialists) are likely to employ useless or dangerous procedures. Evidently "experts" (specialists) are all either ignorant or venal (or both), in which case it would surely be better to get rid of them!
I do not consider myself to be either, but then perhaps I am an exception (if our resident medical nut permits such).
Mac
