Its routine inclusion in multivitamins aside, many health-conscious people have deliberately added folate supplement to their diets because of evidence that it has cardiovascular benefits. This is in addition to its established benefit in averting certain birth defects in the developing embryo when taken by women in pregnancy.
One of my favorite physician writers, Sherwin Nuland (How We Die) shares my malaise about the increasing penetration of ‘evidence-based medicine’ into medical practice. EBM is the slavish practice of basing medical decision-making only on the odds established by peer-reviewed research studies. It is all the buzz, and is especially amenable to the managed-care bureaucrats interested in denying reimbursement for healthcare itnerventions that aren’t ‘cost-effective’ or ‘proven.’ Evidence-based medicine, and the ‘treatment algorithms’ that accompany it, largely cripple what used to be one of the central intellectual tasks of the physician — being an intelligent consumer of the medical literature and a creative, indeed artistic, synthetist of research findings with one’s own clinical experience and the more anecdotal wisdom of one’s colleagues.
There are so many flaws with this way of doing business that I cannot begin to enumerate them in any better way than Nuland has done here. Just as consistency is the hobgoblin of small minds, the belief in ‘objectivity’ is sometimes little more than the last resort of the uncreative, the subjectively challenged. The practice of medicine has been considered an art as well as a science; imagine if artists in other fields were constrained to produce only the types of art the market researchers had ‘proven’ would sell to the masses, or the cognitive psychologists and neuroscientists had ‘proven’ would activate the proper aesthetic centers in the brain as measured by PET scan or fMRI?
The so-called objectivity of medical research is a misnomer in many ways, among them the prejudiced opinions about what is worthy of publication of the academic journal editors and referees; the bias in favor of positive findings at the expense of negative, refutory research results; and the increasing fist-in-glove control of the research industry by the pharmaceutical industry. (Slate)
“When Donald Herbert broke 10 years of virtual silence on Saturday and announced that he wanted to speak to his wife
, his family and doctors were astonished and bewildered.
Mr. Herbert, 44, a Buffalo firefighter who suffered severe brain damage after being struck by debris in a burning building in 1995, had mustered only ‘yes’ and ‘no’ answers sporadically throughout the years, passing his days in front of a television that he could barely see because his vision was so badly blurred.
Neurologists said yesterday that such remarkable recoveries for people with severe brain damage are rare – but perhaps not as rare as the medical literature suggests.” (New York Times )
And, no, just to head off the inevitable Rabid Right take on this, his recovery has absolutely no bearing on Terry Schiavo’s case. You heard it here first.
The New York Times review of the Coachella Valley Music and Arts Festival draws interesting parallels between the shape of a festival and the metaphysics of our technologically-mediated listening habits:
“A few years ago, some music festivals seemed to reflect a world that was increasingly organized around obsessive fan Web sites. Like-minded listeners were forming micro-communities online, and you would see something similar at multistage festivals: ravers in the D.J. tent, hip-hop kids watching the rappers, thrift-store shoppers swooning over the indie-rockers, and so on.
But this year’s Coachella festival suggested a different model: narrow obsession has come to seem less appealing than broad familiarity. Insular Web sites seem positively old-fashioned compared to the scrupulously eclectic world of MP3 bloggers and iPod Shuffle owners, all of them finding ways to make chaos part of their listening experience. As the current Apple slogan has it, ‘Life is random,’ and listeners seem to be finding ways to make that truism true.” (New York Times )