Further Exploration: Evidence-Based Medicine in Brain Injury Forensics

Explore the impact of evidence-based medicine on forensic brain injury analysis with Dr. Goldenberg and Dr. Batson. Learn about the shift to evidence-based practices and the crucial role of the CRED approach in fortifying the trustworthiness of expert testimonies. Journey through brain injury research protocols, uncover ongoing projects, and understand the implications in personal injury litigation. Delve into the intersection of statistical evidence and legal standards, discussing ethical considerations. Join us, co-founders of Brain Injury Research Solutions, in this groundbreaking podcast series, offering resources and insights into the complex world of brain injury forensics.

Learn more at https://braininjuryresearchsolutions.com/  or email us directly at info@braininjuryresearchsolutions.com

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general informational and educational purposes only and is not medical, legal, or
other professional advice. You should not rely on the information provided in the
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Transcript

Introducer Other
00:02
Welcome to the Brain Injury Forensics Podcast presented by Brain Injury Research Solutions, a forensic services and contract research organization. Join Drs Richard Batson and Joshua Goldenberg as they interview nationally and internationally renowned experts and dive into the latest developments in brain injury forensics, applied medical research, state-of-the-art forensic methodologies, gold standard advanced neuroimaging and numerous brain injury related medical topics. 

Dr. Goldenberg Co-host
00:37
This is just a reminder before we start that while we are doctors and have advanced training in forensic medical science and forensic epidemiology, and we will be discussing topics that involve medicine and the law, the information in this podcast is not medical, legal or other professional advice, and this podcast is provided for informational and educational purposes only. You should not rely on anything you hear as a substitute for medical care by a physician or other qualified medical professional or legal advice from a licensed attorney. Always consult with your physician or other qualified medical professional for medical advice and an attorney for legal advice.  

01:23
Hello everyone and welcome to the Brain Injury Research Solutions podcast. We are live with Dr Batson and Dr Goldenberg, Josh and Davis, and we are going to be talking today about research. Don't go anywhere. This is essential. Don't freak out on us. This is the major thing that's been missing, we think, in the forensics approach so far. So, Dr Batson, maybe give us a little bit of an introduction here. What are we talking about with research and how does this play into the credit approach that we introduced a little bit ago? 

Dr. Batson Co-host
01:50
Well, I think, josh, we're going to switch it up today and I'm going to kind of interview you Awesome, Because research is your area and what we're going to be talking about today is the second aspect of the credit approach. Recall that in the last couple weeks we defined the credit approach and then last week we interviewed Michael Freeman regarding the C in cred, which stands for causation or formal causation methodology. Recall also that the credit approach is an attempt to codify or create a structured approach to establishing credibility for expert witnesses in the personal injury forensic setting. 

Dr. Goldenberg Co-host
02:32
Desperately needed. 

Dr. Batson Co-host
02:33
Desperately needed, and part of it is a reaction to the climate that we entered into when we began doing forensic work of what we would say less than optimal. 

That's polite Political Less than optimal, yeah, or we can call credential appeal or, in some cases, misuse of credentials, based on what Michael Freeman called last week eminence-based medicine I love that phrase as opposed to evidence-based medicine, which we're going to talk about today, and so I'll introduce Josh or Dr, goldenberg. Josh, tell us a little bit about your background. You've been doing teaching and I know it's at a number of different universities, been teaching evidence-based medicine for a number of years. Can you give us a little bit on your background? 

Dr. Goldenberg Co-host
03:25
Yeah, so I got the bug. I was just talking to a colleague who we were talking about this, so I got the bug maybe 15 years ago or so, and I remember exactly where I was, if you can believe it or not. I was listening to a lecture on evidence-based medicine. There was a road show that was happening with Dr Zwicky and we'll have to have her on the pod at some point. She is at Health God Research Institute, where I'm affiliated now. She's a Yale-trained immunologist of all things. But she really believed strongly in bringing evidence-based medicine to the forefront of training and so she developed this training course and I took it and I was like this is amazing, this is exactly what medicine needs to practice, medicine from a base of evidence, et cetera, et cetera, et cetera. 

And I was hooked in that moment and haven't looked back and so, yes, over the years I've taught it now in numerous institutions. I taught it at Bastere University, I teach it now at Health God and also at AIHM, which is, I think, the only US-based interprofessional medical fellowship. So it's really kind of cool. I teach like medical doctors, dos, chiropractors, naturopathic doctors, all together doing their fellowship together in integrative medicine. So I teach their critical evaluation and evidence-based medicine coursework, and so I'm pretty hooked, and then most of my research has been on that as well, and then that's how we met. Actually, I think it was through one of these workshops that I gave right. 

Dr. Batson Co-host
05:02
Yeah, I recall. I think it was back in 216 or something around that time. 

Dr. Goldenberg Co-host
05:07
Yeah, I think there were some questions in the back and I think we were kind of like geeking out about evidence-based medicine. And yeah, I mean to your point briefly, like I think, with that obsession with the need to reform medicine through evidence, and then you introduced me to the forensics world and I'm like, oh my gosh, like this, this world is like 50 years behind the times. You know, you're doing this eminence-based medicine, like Dr Freeman was saying we, you know we call it like narrative or you know, pontificating from up high hair doctor, professor, all that kind of thing, and it's like this doesn't happen in medicine anymore. How is it happening in forensics? 

Dr. Batson Co-host
05:43
Well, let's go back in time because I think I think for the listeners, part of it is why is this relevant to personal injury litigation and forensics? And we're going to talk about why it's relevant, but let's go back in time a little bit to the beginnings, the history behind evidence-based medicine and what it was a reaction to. Yeah, because you mentioned the idea of eminence-based medicine. We both did in an appeal to authority and I believe that evidence-based medicine was a reaction to that very problem. Yes, so can you take us back in time and talk a little bit about the history of evidence-based medicine? 

Dr. Goldenberg Co-host
06:20
Yeah, I love that. So I think you're right. The parallels are really strong. So basically the way medicine was taught up until the 90s and everywhere was you know you had these fancy professors that had tenure and they would just kind of pontificate about you know what the best way to do it was and you know they had a lot of clinical experience and that was awesome. But also there were lots of problems there, right? People had subconscious, unconscious biases. They had their own personal experiences that may not have been relevant all the way through. We think in heuristics as humans so even very eminent, you know, clinicians would have these shortcut ways of thinking and sometimes that led to issues. 

One of the best examples of why evidence-based medicine was needed, I think, is this great example that Gordon Gaiak gives, who's sort of the father of evidence-based medicine, and basically it's a story that the research supporting the use of like clot-busting drugs for stroke basically like came on the floor in the 60s and was like well-established by the 70s and like without a shadow of the doubt, was like the right thing to do by like the 90s, but yet it hadn't made it to textbooks by, I think was like a two and a half decade lag. And so his point was really like you had all these professors teaching students the way that they learned, and yet you had all this evidence accumulating that nobody knew about and no one was incorporating. And so you really needed this drive of teaching and practicing based on the most cutting-edge research. And so he spearheaded this. He studied. 

What was the name of his professor? I'm blanking on it now. He died recently, but anyway it'll come to me in the middle of the night, but anyway. So he studied under this guy who was really into mentorship and bringing science to medicine, and then Gordon Gaiak was the first person to publish a paper using that phrase, and he's pretty much done the majority of the heavy lifting of the evidence-based medicine methodology since then. He's still in practice. He's still doing research at McMaster University. 

Dr. Batson Co-host
08:29
What are the for the listeners? What are the nuts and bolts of evidence-based medicine? And then, once we understand those nuts and bolts, let's talk about how we can apply that to personal injury litigation and, of course, our specialty being brain injury, traumatic brain injury litigation in particular. So run us through the nuts and bolts of evidence-based medicine. 

Dr. Goldenberg Co-host
08:51
Yeah, I think at core. So the way people think about evidence-based medicine is sort of threefold. So one is clinician experience it's still important. The other is patient values, which is very important. 

But the third tenant, which I think is most relevant to what we're talking about today, is using current best evidence. 

And those two those two words, current and best is really really important, and basically what that means is we need to be aware of all the available evidence on a question and be up to date and current and use your due diligence as a phrase you use a lot, which I really like to make sure that we have at our fingertips all the data that's available for a clinical question and then we have to be critical about it and select the best bit of evidence, right, so, current and best, and so that's to spawn to whole decades of work and methodology about, you know, determining the quality of research and risk of bias and all that jazz. But at core, that's what it is you need to gather all the evidence in a quantifiable way, ideally. So sometimes we talk about systematic reviews and evidence synthesis and we need to critique it and give a quality assessment and know what to trust, and that needs to inform the clinical question in front of us and, in our case, it needs to inform the forensic question in front of us. 

Dr. Batson Co-host
10:10
What are the types of studies in evidence-based medicine? What are the buzzwords if you're looking through literature and you want to understand if there's been a comprehensive evidence-based medicine approach. When you're going on PubMed or Google Scholar or even just a gray search on Google, what are we looking for? What are those key components or types of studies? 

Dr. Goldenberg Co-host
10:32
Yeah, I think probably the best thing you're looking for, the most obvious is going to be systematic reviews. So that phrase is systematic reviews and that's become very, very popular. And, in short, what that is is essentially you are systematically reviewing the entire medical literature, ideally on a clinical question. So if you want to know the prevalence of post-traumatic epilepsy like you get a concussion and then you develop epilepsy how common is that you need to search through multiple medical databases, tens of millions of potential citations, really targeted searching, screening through thousands of potential hits, all the way down to finding the gold in the rock or the needles in the haystack type of thing where you've got maybe a dozen or two dozen studies on your clinical question from the millions of potential searches. So that's an exhaustive search. And then the systematic way is doing it in a way that anyone could replicate, that You're not just going after the studies you know about or that supports your opinion or your cherry picking. You're really systematically reviewing the literature for everything that's relevant and then you're synthesizing it in one way or another. 

So I would say the buzzwords are systematic review. The other buzzwords are guideline and for multiple reasons we just have to be very cautious both about guidelines and systematic reviews. They're not all created equal. Some are garbage, some are great, some are middling, but those are things to look for. And then the third would be some measure of quality of that systematic review and guideline which, as you know, because I'm obsessed with it, I really like grade, which is sort of the standard accepted by the WHO, world Health Organization and BMJ and all the major players as the way to assess the confidence in evidence. 

Dr. Batson Co-host
12:20
Okay, so I have two questions. One of them you mentioned something called cherry picking. Not sure that everybody in the audience knows what that means. I think in legalese we talk about selective use of evidence, in this case, research evidence. So tell us a little bit more about cherry picking. What is it? Why is it a problem and you've read a lot of IMEs at this point in your career, have you seen cherry picking in forensic work? And if you have, how common is the problem? 

Dr. Goldenberg Co-host
12:51
Yeah, so cherry picking is basically you might have, let's say, 30 studies on a question and let's just do a quick thought experiment. So let's say you want to know if something works or not, right, and there are 30 studies on this question and let's just say we have a God's eye view and it doesn't work, right, so, by random chance, some studies are going to find that it works and some studies are going to find that it doesn't work. And if you average them all out, if you've got all the studies available, it would average out to basically no effect, right? So that's the way kind of sampling works. That's the way research works. Now, if you took those 30 studies and you looked at all the, you found them all systematically and you crunch them all together, you would clearly see that there was no effect. Right, you average everything together, no effect. But if you just select the 15 that are favorable, right, and you crunch those numbers, now it looks completely different. Now it looks amazing, like it's a very large effect size, right. 

So that's sort of one way to think about selective outcome reporting or cherry picking and things like this, where basically you're only selecting some of the evidence in front of us to present a very different picture and you see that in research all the time it's a major issue. You've got methods, are dealing with it. But you know, to your earlier question, I have seen a lot of IMEs and a lot of reports from experts and you know what you'll often see is a sort of a narrative discussion of case, you know, with selection of specific citations, that kind of support the position at hand and that you know was sort of standard back in the day. But that's the sort of thing that you and I have been talking about and reeling against is that we really need to be using a systematic approach and presenting all the evidence available. 

Dr. Batson Co-host
14:41
Okay, so it seems like you're talking about the weight of evidence is represented better by a systematic review that's comprehensive, as opposed to a doc or other other providers doing expert testimony, coming in and picking studies that support their viewpoint and omitting studies that don't support their viewpoint. Is that a fairly accurate summation? 

Dr. Goldenberg Co-host
15:03
Yeah, I think it is accurate and I think it's important to think about conflicts of interest here, and we've talked about that before, and so one of the ways so you know if we go up right and in these cases we also have conflicts and so how do we address that in a systematic way? 

And I think the way we've settled on this and I want to get your thoughts on this, because this was really your spearheading you know the way we've kind of settled on this is what's done in the research community, which is you register what you say you're going to do. You know you decide a priori, you know ahead of the time what you're going to do. How are you going to look for the data and what you're going to present, and then you sort of put it up for the world to see, type of thing. And that's kind of how we keep systematic reviewers honest in the research community, because there's lots of incentives there too and you want, you know basically, people to present not just what's sexy and amazing or in line with their funding source, but everything that's out there. And so basically, you say what you're going to report before you know what is out there, and so that's sort of something that we've been adopting in our work as well. 

Introducer Other
16:13
If you'd like to learn more about our unique approach to brain injury forensics, email us directly at info@braininjuryresearchsolutions.com, or learn more on our website, www.braininjuryresearchsolutions.com. There you can sign up for webinars, explore featured papers and learn about the team. Enjoy the podcast. Don't forget to rate us and review us on Apple Podcast to help spread the word. 

Dr. Batson Co-host
16:54
Tell us a little bit more about that. That's sort of what we call an a priori protocol right, and how do you register that? How is that done in essence? 

Dr. Goldenberg Co-host
17:05
Yeah. So I think a lot of the ills that we've seen in the research community can be fixed with this a priori registration, which is you design your protocol before you know the results of your experiment. Right, just like same with evidence synthesis. You design your protocol and you say what you're going to report on before you've searched and found all these studies and looked at them in detail, right Before you've done your data extraction. So in the research community we call that a priori registration, where you are basically posting your protocol for the world to see online with a timestamp, and then you do your report. 

And it's become so important that editors now in major journals won't even accept your manuscript unless you can point to your registration ideally ahead of time, and they're going to be shifting to where it has to be a priori as well. In fact, the major registries will no longer accept your protocol for registration if you've already started data extraction. So literally, they want a timestamp before data extraction begins, and that's the ideal because you can't change your mind later once you see what the results are. And so we've adopted that in our work, where we are essentially doing a similar thing, where we will design a protocol and register it a priori online using either Prospero or Open Science framework, which are the standard research community ways of doing this, and that's a way for us to kind of timestamp what we say is important before we actually look at those papers and do our analysis. 

Dr. Batson Co-host
18:40
What are some of the projects? Remind me, and for the audience that doesn't know, some of the projects that we're working on right now using this methodology, using a priori protocols that are related to brain injury medicine. Can you give us some examples? 

Dr. Goldenberg Co-host
18:56
Yeah, we've got some fun ones. So the one that I'm working on so most closely because it's related to my PhD work, is in post-traumatic epilepsy. So this we're doing a massive systematic review and meta-analysis as well as individual participant data meta-analysis where essentially we're finding all the studies that look at the prevalence, so how frequent it is to develop epilepsy after a concussion. So that's one of them. We're looking at the prevalence of convergence and sufficiency after TBI's of all sorts, traumatic brain injuries of all levels, and that's something that you really sort of highlighted for me of how that can be super, super common and we wanted to get a better sense of how frequent that is based upon, like how it's defined and the severity of the TBI, etc. We're doing work on diagnostic thresholds on testosterone. We're doing work on quality of life around growth hormone replacement, which is not common but can happen after you tell me can happen. After a TBI you can develop these growth hormone deficiencies. 

Dr. Batson
Co-host 20:09
Correct, correct and yes, it is fairly common. In fact, our data that we're about to publish suggests about 18% in individuals who have had a mild TBI who present with chronic post concussion symptoms to endocrine specialty centers at 12 months after injury. 

Dr. Goldenberg Co-host
20:25
Wow, that's crazy. 

Dr. Batson Co-host
20:27
So pretty common about one in five, a lot more than what you would imagine with simple concussion. 

Dr. Goldenberg Co-host
20:32
I would have thought much less than that. That's so interesting and right. And the question is okay, if they take this growth hormone replacement, does that improve their quality of life? So that's kind of what we're looking at right now. We're doing some cool microbiome stuff, doing a lot of neat studies peripherally around traumatic brain injury. 

Dr. Batson Co-host
20:48
Well, yeah, we had a post. We had one on post traumatic psychosis, mm hmm, that was cool. We had one on the association between PTSD and psychosis and, of course, PTSD happens in anywhere from 22, 28% of individuals after motor vehicle collisions, depending on whether they're male, 22% or female 28%. So a lot of important questions we're trying to answer in terms of dementia too. 

Dr. Goldenberg Co-host
21:13
That's a big one. 

Dr. Batson Co-host
21:13
Dementia, dementia risk we just finished Concussion and future risk of dementia. So I want to ask you for the audience you're using this term, prevalence, which not everybody knows. Tell us what prevalence is and why it's important to understand prevalence in personal injury litigation. 

Dr. Goldenberg Co-host
21:32
Yeah, okay, great point and good job. Calling me out on that, I tend to use these phrases without any thought about the audience Apologies and thank you, so yeah, so it's sort of like and it's used in different ways point prevalence et cetera. But essentially the crux of it is if you wanted to know within a year how many people who got a concussion, what is the rate of those people developing epilepsy, that would be prevalence. So if it was 5%, then you would say within a year period, there is a 5% prevalence of post-traumatic epilepsy after a concussion or TBI or something like that. So that's what we're talking about, basically like what is the rate of something after an event. And the reason that's important is if you have personal injury event, right. And then if something happens right afterwards, right. 

So Dr Friedman's famous example is like if you find someone with a butthole in their head and they're dead on the floor, like, you kind of know the causation there, right, but it's usually not that simple. So if someone develops epilepsy and to stick with this example, and two years prior they had a concussion from a personal injury case and maybe even they have a family history of epilepsy, right, or they have some genetic risk factors for epilepsy. The really complicated question is causation. What's the association here? What's the prevalence at two years of getting epilepsy, post-concussion, let's say? And how does that relate to and we're sort of mudding the waters here with our C and causation and the credit approach what is the comparison of that risk with other risks baseline, biological, et cetera to try to determine causation there? So that's us using research methods, sort of state-of-the-art evidence synthesis methods, to get numbers behind to support these causation arguments that we talked about with Dr Freeman last time. 

Dr. Batson Co-host
23:38
So let's break that down a little bit more so the audience gets a sense of how we actually use prevalence data and why it could be a powerful tool in establishing causation. So it seems to me what you're saying is, if we've got something where we have an immediate onset we have a facial bone fractures with a report of loss of smell within two to three days of an injury fairly straightforward, that the loss of smell is likely due to the facial bone fractures. But we have a different situation here. We've got what we call a latency or a delay in onset. So now we have somebody that develops seizure disorder, epilepsy two years after a brain injury. Is it possibly related at all? 

Now, intuitively for me, I would say if I didn't know what I do know, I would say no, it's probably not related. There's too much of a gap in time for this to be related to the injury in question. So I think we should do another podcast on latency with some of the conditions that happen after concussion and more severe types of brain injury. But is it plausibly related in a causal way? And how would you use prevalence versus, say, the baseline risk or the risk of developing epilepsy in someone who didn't have a brain injury to come up with a more probable than not opinion about that. 

Dr. Goldenberg Co-host
25:01
Yeah. So this is really fascinating work and this is the type of stuff that I think got both of you and me really excited about forensic epidemiology. But there's a whole field behind this, mostly spearheaded by Dr Freeman, but essentially the idea is so, if you think about his inference approach, which we touched on briefly last time, which is basically, if it's really obvious, like you got smashed in the face and two days later or 24 hours later you lost your sense of smell, like that's pretty clear you probably don't need a quantitative assessment there. But in your example, where it's two years out and they're developing epilepsy and there's competing causes, including background or genetic or whatever it is now, you might need this quantitative assessment. So how do we do this? So we essentially run some numbers to get a ratio here to basically say, okay, within this time period from the injury in question to the onset of symptoms or to the onset of diagnosis let's say it's two years in this case what are the chances that this person, if they were like Dr Freeman likes to say, if they were just at home on their sofa doing nothing else, what are the chances this person at this age, with these demographics, et cetera, would develop epilepsy and that's your initial baseline risk. 

And then you say, okay, within this two year period, what is the rate or the prevalence of developing epilepsy after a concussion? And you basically compare those numbers. Sometimes that's called like a comparative rate ratio, sort of analogous to a risk ratio, where essentially you're comparing the rates of two things. And what's kind of really neat is most well, not most courts, but many courts have now accepted this idea that if your comparative risk ratio or comparative rate ratio is two or greater meaning it's two times more likely that your epilepsy is from the concussion versus just sitting on your sofa, that is a more likely than not argument. That's a quantitative way, that's a statistical, mathematical, epidemiological way of saying this is more likely than not caused by XYZ, and so that's how these numbers are very, very useful to us. 

Dr. Batson Co-host
27:20
So let's break that down a little bit more. So let's say that you've got a 5% chance. You've had a brain injury. Exactly two years after the brain injury you develop seizure disorder and you have a 5% chance. After a comprehensive, systematic review of all the medical literature, your best estimate for that risk is 5%. And then we find out that if you haven't had a brain injury and you have no other potential causes of seizure disorder, that your risk of spontaneously Developing seizure disorder over a two-year period is approximately 1%, then you have five times the chance of developing Seizure after brain injury, or five to one comparative risk, which far supersedes the more probable than not criteria. Is that that's a correct application? Yeah? 

Dr. Goldenberg Co-host
28:14
yeah, yep, that's right. And and you can kind of flip it and get this probability of causation Equation, which is, you know, simple math, but basically if it's a two-to-one comparative risk ratio, so if it's two times more likely, that translates to 50% or a little bit more Like the probability that is caused by what we're talking about, right, so as that ratio goes up, as that number goes up, as that numerator goes up, your probability of causation goes up as well. And that's kind of the idea. And so sometimes you know you get something where it's just such a rare event to occur naturally out in the wild. 

You know, so to speak, that you know it might be a hundred to one Risk here, and you're literally talking about like a 99% or higher probability of causation, right, and so it's not saying that we know for sure this is important. It's not saying that we know for sure what caused what. Right, we don't have a God's eye view, but we're using statistics and Epidemiology to basically say, well, we don't know for sure, but what's most likely, and that's kind of the the legal bar is more likely than not, right. And so the neat thing is we're actually able to do that with research evidence available to us. 

Dr. Batson Co-host
29:24
Well, we do. We get that, for example, with my area of research, which is one of my areas of research, which is post-traumatic growth hormone deficiency, and so we see about an 18% or let's call it one in five risk, given that they have chronic symptoms at greater than 12 months, versus the idiopathic or spontaneous onset of adult growth hormone deficiency, which is roughly one in 10,000. 

Dr. Goldenberg Co-host
29:47
Wow. 

Dr. Batson Co-host
29:47
Yeah, so that's a huge. So we end up getting a probability of causation around 99.97%, after we've excluded other organic Pituitary diseases from a from a dynamic pituitary MRI. 

Dr. Goldenberg Co-host
29:59
Yeah. 

Dr. Batson Co-host
30:00
Yeah, so the probability of causation for that particular condition is Extremely high, monsters. 

Dr. Goldenberg Co-host
30:05
Yeah, it's almost guaranteed, and of course you know. 

Dr. Batson Co-host
30:08
You know it's not normal for a forensic expert to come in and and exceed the more probable than not criteria, and that's often surprising when you've applied prevalence data, evidence-based medicine with systematic review yeah, we've looked at baseline versus Post-traumatic exposure risk and then you've done a relative or comparative risk calculation With an actual number for probability of causation and they ask you if it's more probable than not and you say no, it's actually far exceeding that. It's 99.97% probability. Yeah, and, and attorneys aren't used to that, and yet that is the most advanced Scientific way to approach causation. Yeah, and you can. You can come up with numbers like this. Once you understand the medical literature and you've given it a fair and comprehensive appraisal, you can come up with with numbers that are mathematical, that exceed the more probable than not criteria, sometimes In in extremes, yeah, and other times, you know, just meeting the threshold. 

Dr. Goldenberg Co-host
31:10
Yeah, that's right, and I think that's a good place to end it, which is, you know, and that's sort of what we're trying to do in a nutshell, is bring these methods, these high-quality methods from research and medicine, and Apply it in a forensic place where we're getting high quality numbers going into this equation, to kind of make a causation argument. And that's why, you know, we think research like high quality research is so important. People, you know, mean different things when they say research, but for us we mean, you know, we're using standard, high quality research applied to a specific case To sort of drive these mathematical approximations of causation. 

Dr. Batson Co-host
31:47
Fantastic. Well, this was really insightful. I appreciate you taking lead on this, dr Goldenberg, and sharing your background in evidence-based medicine and how we're applying that in the forensic setting. I think next time we come back, we're going to be looking at the third pillar of the credit approach, which is going to be ethics Nice, and we're going to be looking at some of the ethical guidelines from the AMA, the American Psychological Association, and others, and we're going to look at how those interface with the use of evidence-based medicine. For example, selective use of evidence, evidence which is cherry picking, is something that's frowned upon in some of the ethical guidelines, and so, even though you it doesn't explicitly tell you that you need to go out and do a systematic review and Apply rigorous evidence-based methods methods, it's actually implied in some of the ethical guidelines. Yeah, so we'll talk about those ethical guidelines next time we meet and Appreciate everybody. Tune an end today and we'll we'll talk with you next time, take care everyone, bye. 

Introducer Other
32:49
Thank you for listening to the brain injury forensics podcast with doctors Batson and Goldenberg, brought to you by brain injury research solutions. If you'd like to learn more about our unique approach to brain injury forensics, email us directly at info@braininjuryresearchsolutions.com, or learn more on our website, www.braininjuryresearchsolutions.com. There you can sign up for webinars, explore featured papers and learn about the team. Enjoy the podcast. Don't forget to rate us and review us on Apple podcast to help spread the word.