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LETTERS: Martin Offringa Consider validity, clinical relevance, and applicability of albumin for critically ill patients BMJ 1998; 317: 343 [Full text]

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Dangers of so-called "Evidence Based" Medicine

David Bihari   (5 August 1998)

Dangers of so-called "Evidence Based" Medicine 5 August 1998
David Bihari, Associate Professor, Critical Care Medicine St. George Hospital, Sydney Send response to journal: Re: Dangers of so-called "Evidence Based" Medicine	The debate concerning the use of albumin in critically ill patients is yet another example of sensible medical practice being hijacked by the seemingly unstoppable juggernaut of "evidence based medicine". Since no up-to-date intensive care physician spends his or her time treating "numbers" (eg. the serum albumin), the use of albumin has never been routine in UK or Australian intensive therapy. Furthermore, the suggestion that artificial colloids such as starch are superior (BBC News, St.Thomas's Hospital)ignores their well described blocking effects on the reticulo-endothelial cell system, highly detrimental in the critically ill. What will be the result of the publication of this misleading meta-analysis and poorly judged editorial comment? The answer is - not much ! Certainly, medical practise will not change. All that will be achieved is a feeling of panic in patients and relatives when they see themselves or their loved ones being treated with albumin. Well done the Cochrane Group - a great use of public funds. We might as well close down all our ICUs (especially in the UK (1) since they don't seem to do much good - at least not in the terms of EBM! 1 Metcalfe MA, Sloggett A, McPhersonK. Mortality among appropriately referred patients refused admission to intensive care units. Lancet 1997;350:7-11.