Volume 197 - Issue 11
Junk DNA and the identification of new levels of evidence to guide medical practice in 2013 and beyond
Author: Peter D Jones
Med J Aust 2012; 197 (11): 672. || doi: 10.5694/mja12.11513
Published online: 10 December 2012
Published online: 10 December 2012
To the Editor: This year, evidence-based medicine celebrated its 20th birthday.1 However, it remains difficult to translate research findings to the bedside,2 and many medical diagnoses and treatments are unable to meet the five levels of clinical evidence currently recognised in the United Kingdom (http://evidence basedmedicine.com.au/?page_id=30).
This year, we also learned that what was previously believed to be junk DNA actually does something.3 A plausible translation ...
To the Editor: This year, evidence-based medicine celebrated its 20th birthday.1 However, it remains difficult to translate research findings to the bedside,2 and many medical diagnoses and treatments are unable to meet the five levels of clinical evidence currently recognised in the United Kingdom (http://evidence basedmedicine.com.au/?page_id=30).
This year, we also learned that what was previously believed to be junk DNA actually does something.3 A plausible translation of this finding is that there may also be “medical evidence” that has not previously been appreciated. We may need to consider new levels of evidence — levels 6 to 10. If accepted, these will ensure that all medical practice is finally evidence-based from 2013 onwards.
Level 6: the treating physician confidently states that he or she has seen a case like this before and knows the diagnosis. All senior clinicians insist that this level of evidence is essential to the “art” of medicine. This allows them the right to individually design their own treatment protocol and to not follow guidelines.
Level 7: the nurse unit manager tells the treating team the diagnosis and informs them of the relevant protocol that they must follow, stating, “This is the way we do things here!”
Level 8: the relatives of the patient have told the patient his or her diagnosis, and the doctor is required to either agree with the patient’s family’s assessment or endure a sleepless night worrying about the uncle who happens to be the senior legal counsel in the largest malpractice firm in town.
Level 9: the diagnosis has been identified using Google and confirmed by either an online forum or a pharmaceutical company’s “community information” advertisement. Overturning this category of diagnosis is problematic, as it requires the consultation to last longer than either the physician’s or the patient’s concentration span.
Level 10a: a given diagnosis is required to ensure that either the institution or medical practitioner treating the patient receives maximum payment.
Level 10b: the patient requires the given diagnosis to become eligible for a subsidy/funding. This diagnostic category was first alluded to in 1995.4 Despite this category representing the lowest level of diagnostic evidence possible, if levels 10a and 10b coexist, then it follows that no amount of other evidence is able to challenge the patient’s given diagnosis!
Competing interests
No relevant disclosures.
References
- Cook DJ, Jaeschke R, Guyatt GH. Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis: Journal Club of the Hamilton Regional Critical Care Group. J Intensive Care Med 1992; 7: 275-282. 0_CHDCAFIB
- Scott IA, Glasziou PP. Improving the effectiveness of clinical medicine: the need for better translation of science into practice. Med J Aust 2012; 197: 374-378. 0_CHDFEIAJ
- The Encode Consortium. An integrated encyclopaedia of DNA elements in the human genome. Nature 2012; 489: 57-74. 0_CACICHHF
- Jones PD. Medical Munchausen syndrome. Lancet 1995; 345: 995. 0_CACBBGEI