Monday, April 27, 2020

TWIV Podcast: Evidence-Based Science and Medicine for Covid-19: TWIV 606

TWIV 606: Evidence-Based Science and Covid-19 [Listen to the podcast; get more info and links mentioned in the episode.]

As a Medical Librarian living and working in the current time of Coronavirus,  I've been struggling with what to send people asking for research on Covid-19, when the best available "evidence" is only just emerging and appears on pre-print servers and hasn't had time to perk through all the usual peer review and filters of fully-formed evidence-based practice.  In other words, it's not what we're used to as gold-standard evidence.  What we are seeing is much lower on the evidence pyramid. 

On the one hand, it's an exciting time to see the research emerge and evolve, to witness so many people around the world working to solve this emerging and evolving pandemic-sized infectious disease. It's also more than a little alarming to see the state of the evidence ...

Researchers and physicians are willing to try something/anything if it might help solve some small part of the Covid-19 puzzle.  If they put together very small studies with no control to compare outcomes, what is that study really worth?   

I'm not the only one with these concerns, which is why I was glad to see the TWIV podcasters addressing this topic.   Give it a listen ...    at least the first 45 minutes where
Dr. Daniel Griffin gives a nice description of how physicians make decisions, running the gamut from the ultimate goal of evidence-based practice to all these other varieties we've seen since the onset of Covid-19: 

  • Experience-based medicine (including experience bias)
  • Vehemence-based medicine
  • Eloquence-based medicine (More spin than science.)
  • Diffidence-based medicine ("No good answers here.")
  • Defensive-based medicine
  • Careful observation and experience based medicine 
    • Did it help or hurt?  Stand there and think about it.  Did it work?
  • Evidence-based medicine
Always remember, Physicians are human.  They are subject to the same stress and overwhelm everyone else gets.  Early on in this pandemic, there was an emotional, anxious, desperate response to do something/anything to make a difference in outcomes for Covid patients.  Do everything and see what sticks ...   Now Dr Griffin's advice is to "Don't just DO something: Stand there ... and see if it worked."

What are you listening to to keep up with Covid-19 developments?

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