{"id":676,"date":"2013-09-05T20:28:08","date_gmt":"2013-09-05T19:28:08","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc\/?p=676"},"modified":"2013-09-05T20:28:08","modified_gmt":"2013-09-05T19:28:08","slug":"pilgrimage","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2013\/09\/05\/pilgrimage\/","title":{"rendered":"Pilgrimage"},"content":{"rendered":"<p><a href=\"http:\/\/www.flickr.com\/photos\/devcentre\/130663011\/\">Photo from Peter Harrison on Flickr<\/a><\/p>\n<figure style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\" \" alt=\"Dolphins\" src=\"http:\/\/farm1.staticflickr.com\/47\/130663011_9cb84c1eaa.jpg\" width=\"300\" height=\"200\" \/><figcaption class=\"wp-caption-text\">Dolphins by cheetah100, on Flickr<\/figcaption><\/figure>\n<p>Most communities will have one, two, or more campaigns running to raise money for a child with a health concern. It might be a cancer, a chronic disability or a neurodegenerative condition. The campaign is not for a charity which supports children with the condition in general, or research into the disease process, but for the specific child to go somewhere to receive some therapy.<\/p>\n<p>Is this a difficult situation to address with evidence-based medicine?<!--more--><\/p>\n<p>Professionally, if EBM is about combining clinical research, clinical expertise and patient\/family values then we can do this. We could look for evidence for the intervention (for example<a title=\"Archi Topic\" href=\"http:\/\/adc.bmj.com\/content\/early\/2008\/02\/27\/adc.2007.126573\"> swimming with dolphins\u00a0<\/a>) and discuss this with a family. We could offer them experience and access\/referrals to <a title=\"MCRN\" href=\"http:\/\/www.mcrn.org.uk\/children\">ongoing clinical studies<\/a>, and we can support them in their decisions.<\/p>\n<p>Under all this though, I feel that understanding the dilemma not as a medical problem but as an act of pilgrimage may be more helpful. While sometimes the objective has a treatment that has a demonstrated value to\u00a0it (for example, proton beam radiotherapy for some cancer therapies, with reduced side effects but probably equal efficacy) I think is more usually a underpinned by a miraculous hope (phase I studies or unpublished \/ uncompared procedures or interventions). What may well be the &#8216;treatment&#8217; is not the drug, surgery, dolphin or device, but the support and acknowledgement of the community around the family.<\/p>\n<p>Pilgrimage has a long and honorable history and should be acknowledged by us all.<\/p>\n<p>&#8211; Bob Phillips<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Photo from Peter Harrison on Flickr Most communities will have one, two, or more campaigns running to raise money for a child with a health concern. It might be a cancer, a chronic disability or a neurodegenerative condition. The campaign is not for a charity which supports children with the condition in general, or research [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2013\/09\/05\/pilgrimage\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[79,2681],"tags":[],"class_list":["post-676","post","type-post","status-publish","format-standard","hentry","category-archimedes","category-practice-of-medicine"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/676","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=676"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/676\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}