Evidence-based medicine. What does medicine study?

Medicine is a science that studies a person in a healthy and sick state with the aim of promoting his health, protecting him from disease and treating him. Thus, the tasks of medical science include not only treating the sick, but also promoting the health of the healthy.

It is quite obvious that these problems cannot be solved without knowing how the human body is structured (i.e. anatomy) and how it functions (i.e. physiology). Therefore, medical science is based primarily on these two sciences - anatomy and physiology.

Sometimes they mistakenly equate physiology and medicine. These sciences have different tasks and different ways to solve them. The difference between physiology and medicine lies primarily in the fact that the physiologist studies the general laws of the function of abstract healthy person, the doctor studies these functions in the specific person he examines. In addition, a doctor, unlike a physiologist, must know not only how a healthy body functions, but also what morphological changes and dysfunctions occur in various diseases and pathological conditions. In other words, he must know deviations from the norm, that is, pathology. Otherwise, he will not be able to resolve the issue of the athlete’s health and make a diagnosis of “healthy”. But this is precisely the question that is the main one during classes. physical culture and sports, since it is on its decision that the admission to physical exercise and its dosage primarily depend. In addition, the doctor must be able to treat diseases, injuries and injuries that occur in athletes, which is not the function of a physiologist.

Medicine consists of two large sections: theoretical and clinical.

In addition to anatomy and physiology, the theoretical section includes microbiology, pharmacology and a number of other disciplines.

In the clinical section, i.e. in the so-called clinical medicine, both healthy and sick people are studied - diagnosis, prevention and treatment of diseases, as well as the reactions of a healthy person to various external influences, factors influencing health, ways to strengthen and maintain it.

Studying various diseases showed that, despite external differences, they have common reasons, general symptoms and general patterns of development. It turned out that, although outwardly the diseases differ significantly from each other, they obey general laws. Without knowledge of these laws, it is impossible to study either a healthy or, especially, a sick person, since, without mastering the general patterns of the emergence and development of pathological processes, it is impossible to prevent, diagnose, or treat diseases.

The science that studies these general patterns is called general pathology. Therefore, before studying clinical medicine, and sports medicine refers specifically to this section of medicine, you need to learn the basics of general pathology.

It would seem that medicine, designed to improve and treat a person, should be international and the tasks of healthcare should be the same in both a socialist and a capitalist state. However, this is not true.

Health care in a socialist state and health care in a capitalist state are significantly different.

The tasks of Soviet medicine are determined by the CPSU Program, which has a special section “Caring for health and increasing life expectancy.” Thus, in our country, caring for the health of Soviet people is, as noted above, a state task. V.I. Lenin spoke about this. He considered the health of workers in our country not only as his personal benefit, personal happiness, but also as public wealth, which the state is called upon to protect and the theft of which is criminal.

V. I. Lenin considered public health in combination with the conditions of the material and cultural life of the country and considered it necessary to resolutely strive to improve health, prevent diseases, improve physical condition, increasing the working capacity and increasing the life expectancy of Soviet people.

All these fundamental instructions of V.I. Lenin underlie Soviet medicine, one of components which is sports medicine.

Free medical provision of the population with polyclinic and hospital care, careful monitoring of health status in order to prevent the occurrence of various diseases, starting from the first day of birth of a Soviet citizen, and even before his birth - in antenatal clinics for pregnant women, represents a huge socialist achievement.

Our country has a wide network of state medical and preventive institutions (hospitals, clinics, consultations, etc.), carrying out all preventive measures provided by the state. There are 618,000 doctors working in the Soviet Union (as of 1971), which is more than 25% of the number of doctors worldwide.

The situation is completely different in capitalist countries, where qualified medical care is paid for by the patient himself, and it is quite expensive, and therefore not available to everyone. There, caring for a person’s health is a purely personal matter, and the state does not provide medical care to the population to the extent necessary.

All of the above also applies to sports medicine, which does not exist in isolation from medical science as a whole.

Medicine is a system of knowledge, as well as practical activities aimed at recognizing, treating and preventing diseases. This science has an extensive system of areas of work and a very long and rich history. We will tell you more about what medicine is, what its directions are, its history.

We will mention only some of the key events and personalities that have become significant for this direction science.

Ancient world

In these distant days, the blame for diseases was placed on some unknown evil creature, which, penetrating into the human body, gave rise to diseases. A similar approach determined the emergence of shamans and healers, whose goal was to expel the “evil”, which was supposed to promise recovery. At first, various conspiracies and prayers were used for this. Then they began to use herbal infusions and other traditional medicine techniques. Further, healers gradually began to master the method of physiological influence, while simultaneously studying the human body (still at a fairly primitive level).

Significant figures in the field of medicine of this era were Hippocrates, Herophilus, and Galen. Also at this time, treatment methods such as acupuncture, Ayurveda, and massage were born. In later years, the rudiments of dentistry were mastered (teeth were filled and removed), surgery (craniotomy was performed, C-section), gynecology (doctors already had a basic understanding of how to promote successful pregnancy, how to behave during childbirth, etc.).

Middle Ages

The acquired knowledge was accumulated and improved. Hospitals were opened everywhere (in particular, at monasteries), including for the insane. There were social institutions where help was provided to poor people.

A corresponding specialty has appeared in higher educational institutions. Scientific treatises and books were written. Observations and experiments are at the forefront.

Doctors from Arab countries and Byzantium made a tremendous contribution to world medicine in the Middle Ages. Significant persons of this time were Harun al-Rashid, Ahmad ibn Tulun, Abu Ali Ibn Sina (Avicenna), Ibn Zuhr. The East dominated the field of medicine until the 15th century. Further, European countries gradually begin to strengthen development in this direction. The Renaissance was already marked by such names as Paracelsus, Vesalius, Harvey, Fracastoro, Pare.

New time

The accumulation of knowledge and the honing of healing skills continue; microbiology and toxicology, experimental pharmacology, and ophthalmology also appear. The foundations for military and naval hygiene are laid.

The number of doctors to whom the world owes outstanding discoveries, is increasing many times over - now medicine is everywhere. Among the Russian surnames are Gaaz, Zakharyin, Pirogov, Sklifosofsky, Botkin, Pavlov, Yudin, Filatov, Voino-Yasenetsky, Ilizarov and many others.

However, despite many centuries of tireless development, medicine still has a huge number of questions regarding human body. Scientists and doctors have not yet learned to 100% effectively combat such serious diseases as cancer and AIDS. They still haven't revealed the secret eternal life. And one of the most important and most mysterious organs of the body - the brain - is barely 10% studied. And this is only if we take into account that he generally has some limits in his capabilities. Therefore, we can safely say that humanity has many centuries of persistent attempts to unravel one of the most difficult mysteries of nature ahead.

Directions of medicine

The structure of medicine is very ramified, and therefore we will give only its key areas and sections:

• Preventive medicine. Deals with issues of preventing the development of diseases and is divided into: hygiene, sanitation, epidemiology.
• Clinical medicine. Engaged in the analysis and treatment of diseases. The areas of this direction are: surgery, therapy, pediatrics, dietetics, psychiatry, gerontology. The following sections are also highlighted clinical medicine: urology, cardiology, ophthalmology, neurology, dentistry, endocrinology.
• Pharmacology. Engaged in the development of drug formulas and their production. Divided into pharmacy and pharmacoepidemiology.

In addition, we can talk about numerous biomedical branches (for example, anatomy, biophysics, molecular biology, physiology, etc.), as well as separate areas of medicine that are tied to one or another type of activity (for example, sports, forensic , space, military medicine etc.).

Finally, there is traditional and alternative, as well as experimental medicine. It is usually used in cases where a person refuses to use it for one reason or another. classical techniques treatment, or in cases where such techniques are ineffective. In particular, this applies to cases with serious diseases (for example, cancer), in the treatment of which modern science is in many cases powerless.

You may also find articles from the section useful.

conventional - ordinary, traditional; common).

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Subtitles

Symbols

In the modern world, four options have received the greatest symbolic meaning for the designation of medicine.

One of the external symbols of medicine since the end of the 20th century is the six-pointed “Star of Life”. A more ancient symbol of medicine is the staff of Asclepius, which, according to legend, belonged to the great healer. The third popular sign is the red cross and red crescent; his fame is closely connected with the activities of the International Red Cross and Red Crescent Movement. The fourth symbol of medicine - a bowl with a snake entwined around it - is associated with Avicenna, who used snake venom in his treatment and ancient Greek goddess health Hygieia, depicted with a cup and a snake.

• Ancient Egypt

  The Arabs were in conditions that seemed particularly conducive to the development of medicine, since Islam encourages the search for cures for diseases and extols those who heal people. Arab medical scientists translated and studied the writings of ancient physicians. Ibn Zuhr (Avenzoar) is the first famous doctor, who performed human anatomy and post-mortem autopsy [ ] . The most famous Arab physicians: Aaron, Baktishva (several Nestorian doctors), Gonen, Ibn al-Wafid (English) Russian(Abengefit), Ar-Razi, Ali ibn Sahl Rabban al-Tabari (Ghali-Abbas), Ibn Sina (Avicenna), Albukasis, Ibn Rushd (Averroes), Abdul-Latif al-Baghdadi.

  Byzantine and Arab medicine enriched the world medical science new descriptions of disease symptoms and medications. The Central Asian scientist Ibn Sina (Avicenna) played a significant role in the development of medicine.

  Medicine in medieval Western Europe

  In medieval Western Europe, compared to antiquity, empirical science was in decline, theology and scholasticism took precedence. Science was concentrated in universities. Starting from the 9th century, in universities in the territory of modern Germany, England and France, along with other sciences, medicine was taught. The treatment was carried out by monks and secular people. The most famous medical school in Europe in the Middle Ages was Salerno. The works of this school were accepted as exemplary in other schools. The most famous was the hygienic poem “Lat. Regimen Sanitatis." Doctors of ecclesiastical and secular rank, as well as women, belonged to the Salerno school. They were in charge of hospitals, accompanied armies on campaigns, and served under kings and princes. Only from the 13th century did a few representatives of medicine of that time show a desire to study the nature of diseases through observations and experiments. Such are Arnold of Villanova and R. Bacon. In the 14th century, the development of anatomy as a science began, based on autopsies and M. de Luzzi (English) Russian(1275-1326) publishes a work containing accurate images of organs. However, until the 15th century, the Arabs dominated European medicine, so that even the works of Galen in Europe were distributed in translations from Arabic.

  Medieval Rus'

  Renaissance

  A significant step in the development of medicine was made during the Renaissance (XV-XVIII centuries). The Swiss physician Paracelsus promoted medicine based on experience and knowledge, and introduced various chemicals and mineral waters into medical practice. A. Vesalius described the structure and functions of the human body. English doctor W. Harvey created the doctrine of blood circulation.

  In the field of practical medicine, the most important events of the 16th century were the creation by the Italian physician G. Fracastoro of the doctrine of contagious (infectious) diseases and the development of the first scientific foundations of surgery by the French physician A. Paré.

  New time

  The growth of industrial production has attracted attention to the study occupational diseases. At the turn of the 17th and 18th centuries, the Italian doctor B. Ramazzini initiated the study of industrial pathology and occupational hygiene.

  With the development of medicine, medical educational institutions. In the 18th century V Russian Empire The Academy of Sciences (1724) and the College of Medicine (1763) were created - administrative centers in the field of medicine, and several medical schools were opened.

  In 1773, the Medical Collegium was opened in Lviv, which in 1784 merged with the medical faculty of Lviv University, and in 1787 the Elizavetgrad Medical-Surgical School was opened. One of the main sources that recruited medical school students was the Kiev Academy, where medicine began to be taught at the end of the 18th century (it was opened in 1802 medical grade- his first teacher was A.F. Maslovsky).

  In the second half of the 18th century - the first half of the 19th century, the foundations of military and naval hygiene were laid. The German scientist R. Koch became one of the founders of microbiology. The foundations of experimental pharmacology and toxicology were laid by the French physiologist and pathologist C. Bernard. The works of the German physiologist G. Helmholtz and the Czech biologist J. Purkyne contributed to the progress of ophthalmology.

  At this time, the number of medical schools is increasing.

  Directions and areas of medicine

  Preventive medicine

  Previously this area was called Sanitation and hygiene. It aims to prevent diseases, both in relation to one individual and in relation to groups and populations of people.

  Identifying and treating sick people and preventing the same patient from getting sick again.

  • Dietetics studies the effects of food and drink on health and disease, especially in determining optimal nutrition. A nutritionist prescribes a therapeutic diet for diabetes, cardiovascular diseases, excess weight and digestive disorders, allergies, malnutrition and tumors. (sometimes mistakenly confused with food hygiene).
  • Psychiatry studies mental illness, the causes of their occurrence, methods of diagnosis, prevention and treatment.
  • Gerontology studies the aging processes of living organisms, including humans.
  • Neurology studies structure and function nervous system, patterns of development and possible pathologies, causes of diseases, methods of their prevention and treatment.
  • Endocrinology studies hormones and their effects on the body
  • Ophthalmology studies diseases eyeball, its appendages (eyelids, lacrimal organs, mucous membrane), bone structures and fiber surrounding the eye.

  Pharmacology (pharmaceuticals)

  • Biochemical pharmacology
  • Molecular pharmacology
  • Experimental pharmacology

  Biomedical industries

  • Anatomy studies the physical structure of organisms. Unlike microscopic anatomy - cytology And histology- anatomy studies macroscopic structures.
  • Biochemistry studies the chemical processes occurring in living organisms, the structural features and functions of their chemical components.
  • Biomechanics studies structures and functions biological systems using mechanical methods.
  • Biological statistics is the application of statistics to biological fields in the broadest sense. Knowledge of biostatistics is important in the design, evaluation and interpretation of medical research. Biostatistics is also the basis for epidemiology and evidence-based medicine.
  • Biophysics is an interdisciplinary science that uses methods of physics and physical chemistry to study biological systems.
  • Cytology is engaged microscopic examination individual cells.
  • Embryology studies early development body.
  • Genetics studies genes and their role in biological inheritance.
  • Histology studies the structures of biological tissues using light microscopy, electron microscopy and immunohistochemistry.
  • Immunology studies the immune system, which includes innate and adaptive immunity.
  • Infectology studies infections.
  • Combustiology studies burns and their treatment.
  • Medical physics studies the application of physics principles to medicine.
  • Microbiology studies microorganisms, including protozoa, bacteria, fungi and viruses.
  • Molecular biology studies the molecular basis of the process of replication, transcription and translation of genetic material.
  • Neurobiology includes those disciplines of science that are associated with the study of the nervous system. Basically, neuroscience focuses on the physiology of the brain and spinal cord. Some associated clinical specialties include neurology, neurosurgery, and psychiatry.
  • Pathology how science studies the causes of diseases, their course, progression and resolution.
  • Photobiology non-ionizing radiation and living organisms.
  • Physiology studies the normal functioning of the body and its underlying regulatory mechanisms.
  • Radiobiology studies the interaction between ionizing radiation and living organisms.
  • Toxicology studies the dangerous effects of drugs and poisons.
  • Sexopathology studies the science of sex.

  Selected areas of medicine

  • Underwater medicine
  • Occupational medicine

  Theoretical medicine

  In medicine there are theoretical medicine or

Evidence-based medicine is medical atheism.

A modern doctor must adhere to the best scientific evidence, otherwise he is a charlatan.

Synonym: evidence-based medicine; “evidence-based medicine” (literally: evidence-based medicine), "EBM", "science-based medicine".

What is this

Vasily Vlasov: What is evidence-based medicine

An evidence-based approach to medical practice involves the use of therapeutic, preventive and diagnostic actions with proven effectiveness, which involves searching for information, comparing, conducting research and meta-analyses. Efficiency is proven Not own experience or personal opinion.

In a narrow sense, this means medical practice an individual doctor when he uses in his work only what he has high-quality evidence base of effectiveness (to this Not refers to one’s own experience and personal opinion, they are put in last place - when everything that has been proven is over or the case is extraordinary, then personal experience will do). It is clear that objectivity itself is subjective, especially in medicine, but personal experience is more subjective than anything else, so it is treated as such.
The approach to treatment based solely on experience and impressions is called “impressionistic medicine.”

DM is based on clinical epidemiology, which studies the spread of disease and designs clinical trial methodology to ensure that it leads to evidence-based conclusions while minimizing random and systematic errors and participant buy-in. The main spanner in the hands of clinical epidemiologists is corrupt rubbish statistics, which allows you to systematically observe phenomena in a mass of people, describe all this in numbers and divide by zero by one hundred percent, using clinical trial methods (designs) that allow you to avoid systematic errors.

In general, this is a set of principles for refuting or confirming scientific data.

How does this work

Control

For each study of anything, it is necessary to set a reference point so that the results have something to compare with: if something is 30% better, then we need 0% to understand what is better. Outdated protocols assumed zero to be a simple control group that simply did not take the drug/was not clinically tortured; this has now been rejected: how do we know that the study group is exactly experienced the effect from the drug, and didn’t you invent it through self-hypnosis?

To eliminate the effect of self-hypnosis, control groups were fed useless drugs. Now both the study group and the control group eat tablets that are identical in weight, shape, color, and taste, but some have an active ingredient inside, and some do not. In cases where no one knows, this is called blinding: the experimental subjects don’t know (single-blind), the doctors don’t know (double-blind), even the nurses don’t know, the commission processing the results doesn’t know (triple-blind).

A placebo has no effect on the body; it can be not only a pill, but also harmless magnets from the refrigerator, flashing lights or fake acupuncture, depending on what is being studied.
Recently, control is often carried out not with a placebo, but with conventional treatment (already approved and tested many times), in cases where patients cannot be left completely without treatment. Then one group is given standard therapy, and the other standard + study, and the differences are compared.

Significance

What are systematic reviews?

Each study must have confirmation of its conclusions in a mass of similar ones, otherwise practical conclusions cannot be drawn; There are crowds of experts to analyze and evaluate articles, who ultimately issue clinical recommendations (guidelines) to mere mortal doctors based on the best evidence. When studying work, it is necessary to strictly separate process indicators (any changes in parameters) and indicators of the result itself (they are the ones that have clinical significance) that those changes lead to. When reading publications or arguing with a supporter of a method, one must adhere to this division, since it is not difficult to show the effect of a possible factor on the process, but finding out a reliable result and its positive connection with that factor requires serious work.

Research work can be classified into one type or another according to the weight of evidence, which depends on its structure (by reducing the slope):

1. Systematic review through meta-analysis: the ceiling of evidence at the moment, nothing cooler has yet been invented (except perhaps a meta-analysis of meta-analyses): a pack of similar clinical trials of one method is taken, their common and different parameters are calculated, the agreement/discrepancy of the results is analyzed. The benefit of the method is that it provides higher statistical sensitivity (power) than individual tests, especially when they contradict each other. One of the significant values ​​of meta is that seemingly similar studies have different authors, time and place of conduct, as well as different samples, which almost eliminates the possibility of bias (see below).
2. RCT (randomized clinical trial, "RCT"): a pillar of evidence designed specifically to distinguish between what was due to exposure and what was due to chance. Consists in dynamic observation preventive/diagnostic/therapeutic interventions that are applied to randomized groups from a specific sample of patients. All possible factors have the same effect on groups of experimental subjects, only in one it will be a completely placebo effect, and in the second it will be a direct effect medical intervention, from which you can subtract the first and obtain crystallized reliability in the form of confirmation/refutation of the original hypothesis.
3. Population (prospective, cohort, longitudinal) study: two groups of the population (cohorts), for example, those exposed to a risk factor and those not exposed to it, are identified, then they are observed for a long time, examined and the data are compared. It is used to determine the prognosis and causes of diseases, their risk factors and incidence rates, which is very labor-intensive due to the need for large samples (new cases of diseases may be too rare) and the duration of observation of these large groups.
4. Analytical cross-sectional study: used to assess the effectiveness of diagnostics, the prevalence of outcomes and the course of diseases in almost real time - in fact, it is a slice of the database according to some criteria.
5. Case-control study (retrospective): an archive of case histories is taken and run through statistics, which allows one to obtain relatively accurate data (without external influence - after all, all observations occurred before the analysis), on the basis of which it is quite possible to put forward a hypothesis. Simple, fast and cheap, but prone to frequent systematic errors due to inaccurate samples or poor quality the case descriptions themselves.
6. Case series description: widely used, but essentially the same "many years of personal experience", which has very little evidentiary value, since if a person wants to see something, then he will see it the first, tenth, and thousandth time. In reality it is suitable for descriptive statistics, but in practice it is vilely exploited by money makers and opponents of EBM.
7. Description of individual cases - someone noticed something and wrote an article. Useful for casuistry, but makes no sense in describing global problems and drawing serious conclusions, because Any individual case does not carry reliability in itself. Of course, description rare cases is extremely important for expanding nosological boundaries, but it is wrong to build hypotheses on them.

Evidence

Rating to show which substance really evaporates, which manipulations actually lead to a significant effect, and which are crap and reflexology.

Identified by letters (clinical trial result level):

1. A - steep double-blind RCTs on large samples and systematic reviews with a high methodological level, s;
2. B - systematic reviews of cohort studies, small RCTs, especially with conflicting results;
3. C - non-randomized studies: case-control studies, systematic review of similar case-control studies (the basis for fuflomycin);
4. D - series of observations, individual cohort studies, expert opinion/group of experts, laboratory data.

And in numbers (class of evidence of accepted recommendations):

• Class I: Evidence and/or general agreement that the diagnostic/treatment modalities are benign, useful, and effective.
• Class II. There is conflicting evidence and/or opposing opinions regarding the usefulness/effectiveness of treatment.
  • Class II-a. Most evidence/opinion favors usefulness/effectiveness.
  • Class II-b. Usefulness/effectiveness lacks sufficient evidence/conclusive opinion.
• Class III. Evidence and/or general consensus suggests that treatment is not beneficial/effective and, in some cases, may be harmful.

Special expert bodies are responsible for deciding on the degree of evidence: World organization Health, The Cochrane Collaboration, Society for Critical Care Medicine, British Medical Journal and many others. These same organizations create guidelines - manuals for doctors.

Please note: here Not patient opinions on the topic are taken into account “And I took it and it helped me!” or decrees like “the boss/professor said.”

Demons

"Bias" ( baes), it's the same bias, or systematic errors- This is actually what evidence-based medicine should fight through RCTs and meta-analyses. A study with a good design, a large sample, a clearly written protocol, adequately selected measured outcomes, and fully published results (including reports of past and current participant participation) brings the rate of such errors closer to zero. It is impossible to list all the baes; their number tends to infinity:

• Errors of representativeness (“selecting bias”) - arise due to incorrect samples and can only be eliminated by proper selection of inclusion criteria and randomization.
• Patient bias (“reporting bias”) is an improvement reported by a person, which in reality does not exist, but I really want to show it, because he is being treated and spending money/time. Not necessarily intentional, the very fact of participating in the experiment affects the well-being of the subject, this is called the Hawthorne effect.
• Registration errors (“bias of an estimator” or “positive bias”) - researchers are also pleased when their treatment works, and it doesn’t matter that the patient hesitates with the answer - we interpret it as “helped”.
  • Interest (“funding bias”) - in the amount of sponsorship money or the researcher’s own vanity.

Of course, even taking all this into account and obtaining a high-quality result, we have to take into account non-modifiable, non-specific and work-independent factors: for example, the fact that diseases have a limited period of peak severity of symptoms, which will decrease without treatment - many diseases are cyclical or even self-limiting (which is convenient for the development of “anti-cold” drugs - during the observation period, all patients are guaranteed to recover). When using the second control group (which does not even receive a placebo, but simply stands in line for treatment), improvement can also be found there.

Even global Precautionary bias is described.

Birth of supernovas

Since dishonest comrades need something to cover up their incompetence, they get behind enemy lines and use the tools of evidence-based medicine for other purposes. With this in mind, you should approach any scientific work in general, especially when they announce something fundamentally new, be it a medicine or a diagnostic method. If you do not analyze the quality of work and do not check the repeatability of the results, then you can easily fall under the influence of the following methods of earning money and a name.

• Fuflomycins: the description of a series of cases is best suited for their development - it seems to be scientific (people will fall for it), and they are clean before the law. This is how “evidence of the effectiveness” of pseudo-arbidol drugs is born: a pharmaceutical company invites a hungry Russian professor on a date, together they come up with a placebo with the desired properties, and then begin to push it into every sufferer, fortunately the professors have heaps of them. Of course, if not in every first case, then in 95% of patients, the desired positive “effects” of the drug will definitely manifest themselves, and here, meet: “Five-year experience of using fuflomycin. A series of clinical cases. Prof. Zalupkin G.Y.”. If you can't find fault, you'll have to buy it.
• Bullshit scientists: in order to get involved in the scientific community, you can start by describing individual cases - precisely because of the lack of reliability and verifiability, this very last point is loved more than others by all sorts of charlatans: it’s enough to write a pamphlet about a single observation, and voila - you’re already a scientist. Sadly, this is what 99.9% of dissertations rest on.

This is how everything works, and therefore in our country you can find local RCTs according to their own, not international, but local standards, developed specifically to promote the new barbidol, in which it is permissible to recruit 8-15 people (compare with the usual 1500+ for DM) and call it a representative sample without the slightest falsification, yes, yes. Even if there is no direct and obvious interest, no one guarantees that an envelope with several salaries was not delivered to the hungry professor and his boss. Of course, such a problem exists in the West, but the practice there has been introduced for a long time and public organizations and state institutions have already learned to inflate scandals out of every bribe, resulting in millions in fines.

Where to look

Before searching for research, you should study the work criteria described above, and also remember that the mere fact that there is a study of anything in the sources below does not mean Nothing, each text must be studied and checked.

Cochrane Collaboration

The Cochrane Collaboration is the largest international organization for providing evidence or refutation of drugs/methods through meta-analyses, bringing together many disparate data into common themes. Much more convenient, but the index is still small compared to PubMed.

The findings of Cochrane meta-analyses are far more important than anyone's personal history of years of experience with any drug, because their systematic reviews have the greatest methodological rigor. , , , .

• What is Cochrane evidence and how can it help you? .

FDA

U.S. Food and Drug Administration- American Food and Drug Administration, a fairly authoritative source of information about confirmations/refutations of the effectiveness and safety of drugs, which has repeatedly shown itself to be resistant to yet another useless dietary supplement. In essence, this is a state-owned American Cochrane.

Reader, remember: every time there is an irresistible urge to crow about the topic “These unspiritual Americans, they only harm us for the sake of money, we have something worse of our own!!!1”, you need to go to the website of the most popular pharmaceutical reference book in Russia, open any substance that came to hand and see there a fascinating phrase: “Category of action on the fetus according to FDA».

• Checking internationally approved and registered drugs on the official website: Tyts.

NCBI

The National Center for Biotechnology Information- National (American, of course) Center for Biotechnology Information. It cannot be said that there is All, but a database larger than theirs simply does not exist. Therefore, you have to know English and translate enemy information.

PubMed

This is such a Google medical research. Thanks to its good selectivity, outright slag usually does not end up there. However, you have to sort through heaps of useless information for any request. It is considered the most authoritative archive of all serious research.

Just enter the desired word/phrase, look for the necessary information and translate day and night. Searching there is an entire art, but it is necessary for a modern doctor.

MeSH

A reference book of terms is essentially a cloud of tags for articles on PubMed. It is needed when it is difficult to find words to search for, and it is very convenient when you don’t know what exactly to look for.

More

• (America);
• CDC - Center for Disease Control and Prevention (Europe);
• High-quality search engine for the drug database rxlist.com;
• DSLD - Dietary Supplement Label Database - NIH's database of dietary supplements;
• An excellent way to find verified data is the English Wikipedia, where the articles are much more elaborate and proof from research is provided for every word.

More

• Russian Society of Evidence-Based Medicine Specialists.
• Russian stronghold of evidence-based medicine on the Internet;
  • Discussion of evidence-based medicine in this stronghold;

Home reading

• Evidence-based medicine and principles of drug development;
• Study guide “Basics of DM”;
• Chewed for patients once, three times;
• Clinical epidemiology and evidence-based medicine as healthcare and medical technologies. Terminology problems. Zorin N. A.

Medicine is a field of scientific and practical activities, which is aimed at studying and treating various types of pathological conditions human health (body condition), identification in various ways and methods of treatment and maintenance normal functioning human body.

The word “medicine” itself comes from the Latin medicina - which means healing. Naturally, the need for healing - treatment - has always existed, in fact since the development of mankind, but it is believed that the beginning of modern medicine was laid by the famous ancient Greek physician and researcher Hippocrates, who lived in the 400s BC. on the island of Kos. Then he earned great respect from his contemporaries and subsequent descendants (he was even credited with being related to the god of medicine, Asclepius, who was allegedly considered his father). He left behind a collection of medical treatises - the “Hippocratic Corpus”, which not only states that all diseases occur exclusively from natural causes, but also laid the foundations for scientific medical research and developed the first physician’s code in history, the main principle of which is the statement - do no harm. At the same time, due to the existence of a ban on opening human body, some assumptions and conclusions were somewhat erroneous.

Medicine symbols

Medicine has its own symbols. The most ancient is the staff of Asclepius, which belonged to the great healer, the Greek god of medicine and is a staff entwined with a snake. The external symbol that appeared at the end of the 20th century is the six-pointed Star of Life. Its six rays symbolize the main tasks that are fundamental to the activities of rescuers in emergency situations: to detect; notify; show a response; help on the spot; help during transportation; transfer to a specialized assistance center. Another popular symbol of medicine is the red cross, which is a symbol of the international movement (Red Cross Movement).

Disease - disease

Disease is the main subject of medicine, both science and practice. Disease is defined as a condition of the body, expressed in disruption of its normal functioning, life expectancy and ability to maintain normal homeostasis.

Scientists still argue about the essence and causes of diseases. In ancient Greece it was believed (Hippocrates) that any disease occurs due to an imbalance of four fluids in the human body: bile, mucus, yellow and black blood. Democritus also believed that this is due to the fact that some atoms acquire irregular shape or incorrectly positioned. In the Middle Ages it was believed that painful condition caused by the state of the human soul, which is struggling with the disease. Along with these opinions, at all times, scientists also determined the cause of the disease - a violation physiological state the human body with its environment, anatomical state and the effects of pathogenic organisms.

Generally accepted classification diseases and areas of medical practice:
- internal diseases (therapy) - the main method of treatment for which is the use of medications;
- surgical diseases(surgery) - which can be cured only through surgical intervention;
- malignant diseases (oncology) - they are caused by various types of defects in the body's cells;
- hereditary (genetic) diseases - they are caused by gene defects;
- gynecology - diseases of organs that are involved in pregnancy and childbirth;
- skin diseases;
- eye diseases (ophthalmology);
- infectious diseases - caused by the influence of various microorganisms on the human body;
- sexually transmitted diseases - transmitted (mainly) sexually;
- mental illness (psychiatry) - expressed in a violation of the ability to objectively perceive reality;
- otolaryngology - diseases of the ear, nose and throat;
- pediatrics - diseases that affect children;
- dietetics - diseases due to poor nutrition;
- intercurrent diseases - or as they are also called in everyday life - complications (for example, dysbiosis due to treatment of influenza with antibiotics).

Types of medicine

There are several types of medicine, depending on the ways of understanding the interaction of processes in the human body and approaches to treating diseases. Thus, a distinction is made between traditional medicine, Western medicine, Eastern medicine, scientific medicine, alternative and traditional medicine. In recent years, the concept of Internet medicine has also emerged.

Traditional medicine is defined as a system (a set of various methods and approaches to treatment), aimed at preserving human health, maintaining it, preventing and treating diseases through correction and restoration of impaired functions natural means techniques and methods.

Western medicine. Modern Western medicine views man as a biosocial system. It is believed that the disease first strikes physical body, and subsequently, as the disease progresses, this leads to psychological oppression. basis western medicine are a set of clinical theories and treatment strategies that involve the use of pills, injections, surgical techniques, radiation, etc.

Eastern medicine- distinguishes four levels in a person: the physical body, the meridional system, emotions and psyche. Eastern doctors believe that disease initially originates in the depths of the mind.

Scientific medicine is integrally connected with scientific experiment. Its main goal is to find new ways to treat diseases.

Alternative medicine - this concept is quite broad and can be interpreted in different ways. Basically, alternative medicine is medicine that goes beyond the generally accepted medical doctrine.

Traditional medicine - includes a set of methods and means of traditional (non-professional) healing. At the same time, modern medicine developed precisely on the basis of the experience of traditional healers.

Internet medicine (online medicine) - involves diagnosing a disease and receiving a doctor’s consultation via the Internet, as well as even performing surgical operations remotely. In other words, when the doctor does not have direct contact with the patient.

Medicine today

Modern medicine has divided into several separate areas that deal with treatment in their own area: ophthalmology (eye diseases); dermatology (skin diseases); gynecology and obstetrics; laryngology and otology (diseases of the ear, nose and throat). The following are successfully developing: desmurgy (rules for applying bandages and treating wounds); operative surgery; mechanurgy (use of surgical instruments); psychiatry; forensic medicine.

To treat various diseases, it is necessary to study a number of sciences. First of all, you must be fluent in anatomy, which studies the location various organs and parts, tissue structure (histology), tissue development and the whole body (embryology). Physiology will help to understand the healthy state of the body, while researching disorders will help general pathology. Bacteriology will help to sort out disorders associated with fungi. Pharmacology deals with the composition and effect of drugs. Toxicology will help you resist poisons. Will bring great benefits pathological anatomy, which will give the doctor material to correctly recognize the disease and prescribe treatment.

Modern medicine is divided into three main branches:
- theoretical medicine;
- practical;
- evidence-based medicine.

Theoretical is aimed at studying the human body, its normal condition, pathological structure and functioning. It is aimed at studying diseases, pathological conditions and methods of their diagnosis, correction and treatment. The basis of this is theoretical knowledge. This is a branch of medicine based on logic confirmed scientific knowledge, offers practical medicine development paths. It summarizes knowledge and creates hypotheses. It is not for nothing that it is considered the first step in practical medicine.

Theoretical medicine

Theoretical medicine makes it possible to develop not only new treatment methods, but also new drugs. She develops a deeper understanding of the mechanisms underlying disease and healing processes. This creates the basis for diagnosis and treatment.

Practical medicine

Practical medicine applies in practice all the knowledge accumulated by science in the treatment of diseases and pathological conditions.

Modern medicine widely applies the criteria of evidence-based medicine, which is aimed at proving the effectiveness of various treatment methods, preventive or diagnostic measures.

The increase in various diseases that are associated with human age is studied by gerontology and geriatrics. They deal with the problems of slowing down aging, prevention in old age, and therapy.

The real test for a doctor begins at the patient's bedside. Here, in a specific case, you need to apply all your experience and knowledge. In this situation, the doctor is faced with a specific person, with his characteristics, his structure, etc. There are no identical patients, therefore the attitude and medical impact must change from patient to patient. Based on anamnesis (previous illnesses), questions, signs of the disease, his knowledge and experience, the doctor makes a diagnosis, as well as makes a prognosis regarding the treatment and course of the disease and prescribes treatment. Such features distinguish scientific (rational) treatment from empirical treatment, in which medicine is given without the knowledge of the patient.

The importance of medicine has always been very great, and it will never lose its significance. Increased success in the natural sciences will contribute to the growth of the importance of medicine.

Paid and free healthcare

Medicine is used by almost all segments of the population, from show business stars to the highest ranks of the state.

According to the Romir research holding, 67% of residents of Russian cities say that they last year used paid medical services. The majority of respondents prefer to pay for medical services at their own expense. The average amount spent by each client on paid healthcare services per year is 8,700 rubles (approximately $300).

The survey involved 1,000 respondents aged 16 to 50 years and older, living in cities with a population of 100 thousand or more, from 8 federal districts. The sample represents the adult urban population of Russia.

Clients in the field of paid medical services women (75% versus 60% of men), respondents under the age of 35, as well as Russians with middle and high income levels speak out significantly more often. The younger the respondents, the more popular they are with corporate and personal insurance, and vice versa - the older they are, the more often they choose “cash payment” with a medical institution.

Compared to 2005, Russians began to more actively use the services of private medical institutions, while the role of state clinics and hospitals in the market for paid services remains predominant. In particular, more than 60% of respondents used paid services in district and departmental clinics and hospitals. Private clinics often choose the most active clients This market consists of women and respondents under the age of 35.

The popularity rating of types of paid medical services has changed slightly over 7 years. Russians began to use paid dentistry services much more often (increase from 63% to 74%). Cosmetology, which previously occupied 12th place, rose to 5th place in the ranking.

Health system

The healthcare system is the totality of all organizations, institutions and resources whose main task is to improve the health of the population of a particular country. State body The ministry that manages the health care system in almost all countries is the Ministry of Health (MOH) or the Ministry of Health within the government. There is also an international body in this system - the World Health Organization (WHO).

The effectiveness of the functioning of the healthcare system in each state depends on the quality of human resources, the amount of funding, the information and communications system, the availability of equipment and materials, transport support, infrastructure (medical research institutes, hospitals, clinics, sanatoriums, etc.), as well as general management.

Thus, it can be assumed that best system healthcare will be in developed countries (Australia, Austria, Belgium, Canada, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Japan, South Korea, Luxembourg, Malta, the Netherlands, New Zealand, Norway, Portugal, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK, USA). At the same time, according to WHO, the country with the best healthcare system is Cuba. Also interesting is the example of China, where the salary of a local doctor largely depends on the number healthy patients on his site. The healthcare system in the CIS countries (Ukraine, Russia, Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan), as well as other states of the former socialist camp, is currently not included in the list of the best, primarily due to the fact that they inherited it from the collapsed USSR , and some reform attempts did not bring the expected results.

Medical institutions

Treatment of patients requires constant monitoring and special care. For this reason, there is a fairly wide network medical institutions and organizations. Although in some cases treatment (when the illness is not severe or during the recovery period) can be carried out at home - under supervision family doctor.

The system of medical institutions distinguishes:
- therapeutic - hospitals and clinics;
- surgical and traumatological;
- pediatric;
- preventive - sanatoriums and dispensaries;
- special - examination departments, ambulance stations, medical stations rescue, blood transfusion stations;
- maternity hospitals;
- centers of alternative medicine.

Popularity of the search query “medicine” in the Yandex search engine

The specified search query shows a steady increase in popularity during 2011 - 2012. Most of the time of the year, the quantitative indicator of impressions on demand is in the range of 500 thousand - 1 million. The peak value was reached at the end of October 2012 and amounted to more than 1.111 million views. The average daily number of views during the first two months of 2013 was 872.5 thousand.

Also, along with the query “medicine”, Yandex users search for:
traditional medicine - 100227 requests in Yandex per month
medicine center - 57727
medicine clinic - 31017
medicine download - 20728
application + in medicine - 20643
family medicine - 20422
medicine treatment - 20139
Chinese medicine - 17585
history of medicine - 15150
forensic medicine - 14172
disaster medicine - 13648
modern medicine - 11344
free medicine - 11178