Cognition based medicine

Cognition-based medicine (CBM) is a proposed methodological system or model that, according to its proponents, extends the principle of the so-called "gold standard RCT" (= randomized controlled trials) of evidence-based medicine. Its application is intended to reduce possible or actual weaknesses of evidence-based medicine by supplementing it with other sources of knowledge. The development of this research method was prompted by a request from the German Pharmaceutical Industry Association (BPI), which was interested in clarifying the term "other scientific evidence" in the German Medicines Act: whether it was "other evidence" in addition to the findings from the usual randomized clinical trials, or "other evidence" in the deeper sense of "building on other evidence."

Origins and basic features of CBM

CBM goes back to the physician and anthroposophist Helmut Kiene and refers to the work of the Gestalt psychologist Karl Duncker on "phenomenal causality". It posits the thesis that valid statements about the effectiveness of certain interventions or procedures are possible not only from controlled studies with large numbers of cases, but also from individual cases, by way of recognizing obvious causal relationships according to certain rules. This causal recognition is actually the basis of the majority of medical interventions practiced today.

Example: The usefulness and effectiveness of a tracheotomy in the case of throat swelling, which would otherwise cause the affected person to suffocate, does not require proof of effectiveness by reproduction or even by randomized studies with an untreated control group and the like, but results from precise knowledge of the anatomical relationships and connections in the throat region (larynx, thyroid, muscles, blood vessels and nerve courses) and expert execution of the incision corresponding to these relationships.

If now for the different kinds of the recognition of causal connections clear scientific rules were developed for the application to the individual case, which the CBM makes its task, then statements about individual patients and the effectiveness of their treatment (their 'outcome') should be able to be made in many areas with the same reliability and validity, as this is the case in the evidence-based medicine with randomized studies with a large number of cases, control group, etc. The CBM does not see itself as a substitute for evidence-based medicine, but as a complementary method. CBM-compliant study designs as well as the merging of CBM-EBM are the goal of the efforts of the supporters of this approach. In particular, CBM should also be used in the field of complementary or alternative medical treatments, where proof of efficacy has not yet been demonstrated with current scientific methods.

Weblinks

• Cognition based medicine on the website of the Institute for Applied Epistemology and Medical Methodology (IFAEMM)