Education And Debate

Evidence based medicine: Socratic dissent

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6987.1126 (Published 29 April 1995) Cite this as: BMJ 1995;310:1126
  1. David Grahame-Smith, professor of clinical pharmacologya
  1. a Department of Clinical Pathology, Radcliffe Infirmary, Oxford OX2 6HE

    SOCRATES: Tell me, Enthusiasticus (Meta-analyticus), they say you are espousing a new form of medical practice. Is that so?

    ENTHUSIASTICUS: Indeed Socrates, and very effective it is.

    SOCRATES: Does it have a name or description?

    ENTHUSIASTICUS: Yes, we have called it evidence based medicine.

    SOCRATES: How very interesting, albeit unaesthetic. But I do find the title that you have given this new form of medical practice rather alarming. I thought that all doctors were trained in the scientific tradition, one tenet of which is to examine the evidence on which their practice is based. How then does this new evidence based medicine differ from traditional medicine?

    ENTHUSIASTICUS: Well, Socrates, one problem is that most doctors have a very narrow perspective, limiting themselves to their own experience and that of a relatively few colleagues with whom they exchange views. This sometimes leads them to make erroneous conclusions.

    SOCRATES: Do you imply that in their narrowness they fail to search for evidence which might cause them to reach a different conclusion or allow them to come to a more balanced decision?

    ENTHUSIASTICUS: Precisely, Socrates, you have hit it in one.

    SOCRATES: How do you, Enthusiasticus, manage to gain access to this evidence which more ordinary doctors find inaccessible? Is it hidden away?

    ENTHUSIASTICUS: Sometimes it is. We have sophisticated methods, using information technology, for searching out and recording information about the efficacy of treatments and case management from all over the world. Also scientists and doctors do not always publish the results of their studies, particularly if they have been negative. I and my colleagues have ways of unearthing such results, …

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