Monday, December 14, 2009

wow. serious insight.

I'm listening to a podcast covering (amongst other things) legislation around surrogacy, and I just had a flash of insight.

The reason why medicine and law so often conflict is that medicine deals with generalities, and law deals with specifics.

When making a decision on how best to treat an individual, doctors use the experience of the previous treatments to guage how an individual may respond to a given treatment. In the last 20 years, the concept of "evidence Based Medicine" (or EBM- which always makes me think of "expressed breast milk") has become the guiding light as to how to best manage people- using research- based decisions rather than 'what has akways been done' or even what seems to make intuitive sense. The gold standard in medicine is the Meta-analysis of multiple, large, randomised controlled trials, involving hundreds of thousands of patients. How we treat diseases like breast cancer, heart disease, all the big ones, comes from this evidence. Even in anaesthesia this is true: a Cochrane review of how best to alleviate pain in labour was published not so long ago*.

However, in law, when an individual decision has been made by a judge, this then determines how subsequent matters are decided, rather than the average judgement made on similar matters, which would be the legal equivalent of the randomised controlled trial.

This means that when medical matters come before a group of legal professionals, they care about the specifics of what the treatment means for any one individual. That is, what will work for that individual, rather than for the large number in a cohort study. Which is impossible to predict, of course. We are judged on what we think the specific patient would want to know in terms of risk for any procedure, rather than what works for a large group.

Hmmm. There's a PhD in this, I'm sure. Which I seriously haven't time for. Next year, can you all please remind me that for a time-pressed full time mum, part time doctor, sewing two onesies, a shirt, a pair of board shorts, a pillowslip (trains, of course) and decorating 8 singlets with hand- made applique is a really bad idea? Especially when said person also wants to finish two skirts for herself before, oooh, tomorrow evening when we have to pack it all into the car to drive to Melbourne?

In other non-related and completely random news:

Julia Gillard's hair is looking better. Nicola Roxon, though, OMG. Get some product, woman! Kristina Keneally's hair, however, rocks. And here I am, an avowed feminist, judging female poiticians by their hair.

Ollie sits up, giggles, pulls my hair, loves his brother and is hoovering into the solids. He is, however, getting constipated enough to give his poor little bum a tear. Blood! on the nappy!! sadness all round

Patrick says the most hilarious things. Coming back from here on the bus (if you're ever tempted to go and you are staying on the Gold Coast, seriously, the public bus service is more than easy to negotiate) the driver swevrved to avoid a car and Paddy said "That was close!".

It's hard rubbish in the next suburb and we are going off to grab a new/old clamshell. Whee!!

Oh and we're having the first (Jen) family Christmas in 9 years. Should be, ummm, interesting.

*The plain English conclusion was something helpful like "An epidural is probably of benefit in analgesia to the labouring woman". Like Derrrr.


Blogger E, SS and the Little Man said...

"That was close" is very funny!

15/12/09 08:53  
Anonymous Anonymous said...

i had the same thought about nicola's hair this week!

16/12/09 01:20  

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