Category: EBM and CQI

How does a pregnant woman effectively and safely minimize or treat physical pain?  Are any medications safe for her developing fetus? What are the downsides to untreated pregnancy pain?  What compensatory measures to reduce pain might be worse than a common medical treatment,. e.g., inactivity vs. OTC pain relivers….? There are a dozen or so reports linking pregnancy acetaminophen use to…

Hypothesis – Therapy X prevents Disease Z and is safe.  So,….let’s randomize 30,000 people into two groups of 15,000 apiece (A and B). Give Group A the experimental “Therapy X” and Group B a placebo…. Monitor for three months, and compare Group A and Group B…. Disease Z occurred in 5 of 15,000 people in…

I love science,….but am forever wary of scientism. Science is observation, measurement, hypothesis-testing, the constant re-adjustment of theories after bias is minimized and experience is analyzed.  Establish what is false, not necessarily what is true. Scientism is the belief that the methods of science must be used for all of human experience, and given time, will settle…

Studying the Vermont Oxford Network Annual Report every Autumn was a delight for me starting back in the 1990’s (the “phone book”).  The information provided by Dr. Horbar and his talented colleagues always coalesced into that desirable admixture of anticipation, surprise, and wonder. Nothing then, and nothing now in the VON summary is more (one…

Apothegms are concise insights addressing Nature’s mystery, and my favorite genre of aphorisms.  Meaningful apothegms avoid cliché, over-simplification, and speak to life-as-lived, in particular the sovereignty of complexity, the unknown, and uncertainty. Prosaic apothegms and mystical apothegms are the two subtypes.  Apothegms are distinguished from maxim and dicta aphorisms by how uncertainty is accepted as…

An abstruse first sentence truncates our yearn to learn.  It dispirits us,……so many books and manuscripts, and so little time.  Worse, it fills turbid the moat around something essential.  “Anyone who’s worth anything reads just what he likes, as the mood takes him (her).” Virginia Woolf reminds us. The attached article exemplifies a regrettably incomprehensible first…

“Remembrance of things past is not the remembrance of things as they were” wrote Marcel Proust. Vladimir Nabokov observed  “The more you love a memory the stronger and stranger it becomes.” 30-some years ago during fellowship training a visiting physician from Ireland ordered phototherapy “on for 4 hours, off for 4 hours”…..which puzzled us.  During NICU rounds…

I possess an unwarranted, requited love of first sentences. No special virtue or wisdom, just an obsession.  Fiction,….non-fiction,….essays,….PowerPoints,….lectures,….text messages.  I try to keep forefront in my mind Lucas/Barzun/Thomas/Turner’s 5 pillars of prose – Clarity, Brevity, Truthful, Meaningful,…….and of course Style, the gorgeous nonpareil.  I fail a lot. My all-time treasure (so far…..):  “The world is my idea.”  Arthur…

Today we struggle with COVID-19, climate change, sectarianism, inequalities,…..yet compared to 75 years ago (specifically August 6, 1945), perhaps our desiderata could be better understood from the lessons of war . John Hersey was an exemplary journalist with fine personal attributes.  He wrote – “….if civilization is to mean anything, people have to acknowledge the humanity of their…

At a QI conference last year a well-known speaker displayed a slide with a photograph of W. Edwards Deming (the ‘father of quality improvement’) with the caption – “If you can’t measure it, you can’t manage it.” I can’t find that Dr. Deming ever said that,….what he did write was – “It is wrong to…