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Rapid Responses: Rapid Responses published:
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Which EBM?
- Alfred P J Lake (9 May 2007)
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the limitations of trading precise answers to the wrong questions fo approximate answers to the right questions
- oscar,m jolobe (10 May 2007)
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What is intelligence?
- Hugh Mann (17 February 2008)
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Alfred P J Lake, Consultant in Anaesthesia and Pain Management Glan Clwyd Hospital, LL18 5UJ
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Like Dr Spence I purchased and enjoyed reading the original work by Sackett and colleagues (1) and have always considered myself to support and, as far as possible, practice Evidence-Based Medicine (EBM) which should not be limited to randomised trials and meta-analyses but involve seeking out the best external evidence to answer the clinical question(s). Applying a narrow definition does indeed impose unhelpful restrictions perhaps making the situation more difficult than it needs to be. Evidence-Based Medicine is now invoked by purchasers and providers for purposes not in line with what was originally planned inappropriately assuming that lack of evidence necessarily equates with lack of efficacy. The description of EBM by Sackett and colleagues however remains apposite, emphasising the individual patient but, including 'best' evidence, requires a value judgement, but by whom? We will benefit all our patients and ensure safe and effective care if we strike the right balance between the purists’ Evidence-Based Medicine and what has been described as Experience-Based Medicine by moving to an all encompassing composite Evidence-Backed Medicine (2), EBM lite? 1. Sackett DL, Richardson WS, Rosenberg W & Haynes RB. Evidence- Based Medicine: How to Practice & Teach EBM. New York: Churchill Livingstone, 1997 2. Lake APJ. EBM for the future. Journal of Evaluation in Clinical Practice 2006; 12: 433-437 (erratum: 2006; 12: 704) Competing interests: None declared |
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oscar,m jolobe, retired geriatrician manchester medical society, c/o john rylands university library, oxford road, manchester M13 9PP
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An acknowledgment of the limitations of a body of knowledge that confines itself exclusively to what is easily quantifiable helps us to avoid the temptation to accumulate what the renowned statistician, John Tukey (1915-2000) would describe as precise answers to the wrong questions at the expense of approximate answers to the right questions. This is precisely what happened as a result of the ease with which left ventricular systolic dysfunction could be equated with subnormal left ventricular ejection fraction(LVEF). The outcome, over some decades, was the missed opportunity to acquire approximate answers to the management of the not so easily quantifiable subtype of heart failure characterised by intact LVEF. This oversight must surely count as one of the most decisive failures of the use of evidence in the management of clinical scenarios which do not easily lend themselves to conventional statistical solutions. Competing interests: None declared |
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Hugh Mann, Physician Eagle Rock, MO 65641 USA
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Society has a one-sided view of intelligence. In school and at work, our intelligence is measured by how fast and completely we can learn. But learning is only half of intelligence. The other half of intelligence is unlearning the many falsehoods that we have been taught. Ironically, most highly intelligent people cling to their education, resist unlearning falsehoods, and perpetuate the harmful effects of these falsehoods, such as sickness, conflict, and war. Let's redefine intelligence to include unlearning, so that our leaders, many of whom are highly intelligent, can have open minds and truly promote peace and health. Competing interests: None declared |
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