Leonardo's Call for Holistic Reasoning

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Leonardo used the term "abreviators" to describe the reductionists of his time:

The abbreviators of works do injury to knowledge and love ... of what value is he who, in order to abbreviate the parts of those things of which he professes to give complete knowledge, leaves out the greater part of things of which the whole is composed? .. oh human stupidity!... You don't see that you are falling into the same error as one who strips a tree of its adornment of branches full of leaves, intermingled with fragrant flowers or fruit, in order to demonstrate that the tree is good for making planks.

I read this quote in Fritjof Capra latest book: the science of Leonardo.These are Capra's own comments:

Reducing the beauty of life to mechanical parts and valuing trees only for their lumbar is an eerily accurate characterization of the mind-set that dominates our world today.

As illustrated in my previous post, Leonardo relied on detailed observations of nature and of his many experiments. Yet, he kept the whole in his mind. In this era of medicine this is what we need. We need not learn more and more about less and less. Instead, we need to step back, and have a deeper look into how things are inter connected. Omeprazole effects on the incidence of pneumonia and Clostridium difficile collitis is a call to step back and connect things.

FORA.tv - Fritjof Capra: The Science of Leonardo

EBM wrongly Instated Epidemiological and Statistical Laws as Clinical Laws

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Having thought deeper in how I have been practicing, I realised that there is an overarching Law in practice Medicine. This contradicts with what I eluded to in my previous post. The overarching Laws in today’s practice are the Laws of evidence based medicine. These are Laws of statics and epidemiology. For example, I believe I have been practicing under these two Laws:

• Randomised controlled trials are to be meticulously applied.
• Our clinical decisions should be based on randomised controlled trials whenever possible.

As the title of this post suggest, I don't believe that evidence based medicine (EBM) should be or is capable of having the stature of a Law. Yes, EBM offers the best available tools for us to discover natures Laws. The Laws of nature, if true are 100% correct. Unlike statistics, Laws have no confidence intervals. We should be 100% confident in Laws.

We needs Laws and not just rules

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This post is another step in my effort to give my opinion in how should medicine evolves.
Recently, I started learning about medical nutrition from a naturopathic approach. Before falling into preconceptions, you must realise that naturopathy as a philosophy started with
Hippocrates, as he states:

It is only nature that heals and wherever and whenever possible nature should be given the opportunity to do so.

A modest way to address naturopathic philosophy is to trust our body's innate capability to heal itself and only intervene when it is deemed necessary.
Having said this, this post is not to advocate for or defend the naturopathic medicine philosophy. But, there is an intriguing point that naturopathy has that we should look seriously into.
Naturopathy has a Law called the Law of cure that collect dispersed facts into one simple Law that once well understood can be applied in treating most of not all conditions. This Law is stated by Lindlahr (1913) as

Every acute disease is the result of a cleansing and healing effort of nature.

Evidence Based Medicine: Why I Became Weary of Those Who use This Term?

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In short, in an effort to make Evidence Based Medicine (EBM) an arching philosophy of practice, EBM had to include evidence that is considered poor by EBM own criteria. The scope of EBM must be narrowed to only be a research paper analysis tool. Unless we do this, we will continue to undermine the quality work produced by McMaster group and many others.
After limiting the scope of EBM, we should come with new and practical tools that allow us to be conscientious, explicit and judicious when making decisions about the care of individual patients. Along this journey, we will probably come with new fancy names to describe this philosophy of practice. These names will not include EBM.

Evidence Based Medicine (EBM) has transformed medicine in a good way. Yet unfortunately, EBM is becoming a buzz word and is often use inappropriately. I am in the process of writing my view of how the evidence in medicine should evolve; in details. But, this is taking more effort than I anticipated. So, for the time being, I thought of writing this short post with some of my thoughts on the matter.

To start, I think the main fault for the inappropriate use of EBM principles falls on those who actually proposed EBM. McMaster researchers that coined the term EBM, described EBM as a method to systematically analyze published research, and to combine this analysis with patient evidence to make clinical decisions . (Oxman et al. 1993) Patient evidence is patient's clinical history, examination, and investigations.

Vitamin B12 level Drops Progressively as Diabetic are on Metformin

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This study is uncomforting. We all agree that the true reason for treating diabetes is to reduce or eliminate its complications. And here, evidence shows that the treatment we give to reduce these complications can cause them!

In this study 19% of 196 diabetics on Metformin 850mg TID had progressive drop in their vitamin B12 levels. This study also assessed folic acid levels. With folic acid there was a non-significant trend for lower levels.

Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial -- de Jager et al. 340: c2181 -- BMJ

Organophosphate Linked to ADHD in A Pediatrics Article: so Naturopath were right all along

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This study compared the level of organophosphate pesticides’ metabolites urinary levels with ADHD symptoms. As these metabolites increased, the prevalence of ADHD increased.

Naturopaths have the attitude to avoid all toxins. They proclaim that low levels of toxicity that does not cause acute illness causes chronic ailments due to the chemical reactions of these toxins with our proteins. Homotoxicology is a science that claims is able to remove these toxins through conjugation reactions that bind these toxins to administered drugs lending these toxins harmless, or at least less harmful.

Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides -- Bouchard et al., 10.1542/peds.2009-3058 -- Pediatrics

Coenzyme Q10 and Vitamin D Lower Blood Pressure, But What Does This Mean?

Coenzyme Q10 lowered 16.6/8.2 in three studies and 13.5/10.3 in others.

Ca 1200 plus 800 vitamin D lowed systolic BP by 13.1 mmHg

You may know that the maximum dose of most antihypertensive doesn't lower BP beyond 15-20 mmHg of systolic blood pressure. And even more important is that just lower BP is not enough as one medicine, Atenolol lowers blood pressure but does not reduce mortality: which is our true goal for treating hypertension.