Sacred Cows

Down with EBM!

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7174.1720a (Published 19 December 1998) Cite this as: BMJ 1998;317:1720
  1. Nigel Molesworth
  1. NHS Centre for Reviews and Dissemination, University of YorK, York YO1 5DD

    We Molesworths hav a noble and distinkuished history of investigating the intrikacies of science. So I hav bin watching the hole evidence-based medicin thing with intrest and it is clere that it is turning into a bunfight. Some say all EBM-ers are arrogant controvershal and seducitve. Others say they are parasites and alkemists. Also many hav beards (my observashun). This is called evidence. Others say: we do not lik all this meat analysis, giv us more bad old reviews the wors the better. All this is simlar to when Peason and Fothering-Tomas call each other names: you hav a face like a squashed tomato no but you are a gurly … all wizard fun, but it is not conjusive to helping new ticks appreshiate what is EBM and how you do it. So it is my plesur to giv you an objecktive insite into the sordid world of EBM and it's practises.

    From my detaled critikle apraisal it apears there are two sorts of doctors, one hav evidence and the other mak up everything on the spot. These fight like 2 cats in a sack only more fur fly & noise is worse. The EBM type ride round the hospital in a cart with atommic computer inside. When patient cry “I have an ague and a fever help help!” the good doctor hop on the cart and cry poop poop like Tode of Tode Hall and ride through the hospital faster than lite. The cart knock all flying & leave trail of dead nurses & patients in wake, so number neded to trete is very high. When Doc arrive he pull out computer & put plug in pashents ear and type in strange sums: out pop likeable risks and rations. The good doctor clap hand to forehed and groan and cry loudly like Fothering-Tomas reding peotry. “Is it bad?” pashent say tremblingly it is wors than bad say Doc. The battry on my psion organiser is dead. All non-EBM doctors eyes lite up friteningly and push Doctor aside, and say dont wory you are safe in our hands. Just take this physik of spiders, flies and stewed lizard. Then they drane pashent of blud and say this is the art of medicin you will be well now. But do not buy any 5 yere diaries just in case. EBM doctor then cry “but you must follow guidlines” and non-EBM doctor pull out guidline written on parchmint, blow off dust and read out loud: “This license the bearer to do what he or she likes, singed, Samule Peeps.” However it is not enuff to whizz round on cart and use computers. EBM adickts must rede Bandoleer which is filled with useful info for decishun makers. There logo is an evil-looking bandit with shotgun which mean they aim to hunt down all non-ebm doctors and blow out there cunning vilanous branes. All doctors also now have the red ebm book, and when there turn comes to be kaned by the hospital manger they put the book down there trousers, and it brake the kane which is super.

    Figure1

    Know the Enemy or Masters at a Glance Some say all EBM-ers are arrogant controvershal and seducitve. Others say they are parasites and alkemists. Also many hav beards (my ovservashun). This is called evidence. ©Ronald Searle, 1954

    It is important to take a historical perspektive on this isshue. All this ruff talk and brusing is normal in the histry of sience. All major discovries were acompanied by mokery and abuse, viz:

    Mr Lister: “I hav discovered that atiseptik practises will prevent zillions of deaths and sickenesses.”

    Jeering colleeg: “Mark mi words no good will come of it. Now bring me some fresh dung to clean my hands, I am off to see my next pashent.”

    So you can see the problem is not new. But wot of the future? Wot indeed. Fortunetely we have a plan so everyone can get along together again. Ebm-ers swank much about there hierarky of evidens, from meta-analysis at top to anecdot at bottom, and say Your study is below RCT, so is No Good chiz. The anser cleerly is for non-ebm doctors to hav there own hierarky. It will be simlar to the other one but upside down. A Hierarky will also be needed specifikly for anecdote-based medcine viz:

    Level I: Beardy old gent from royal college; Level II Doctor with air of credibilty and honest face; Level III: Academic with mad stare; Level IV: NHS manager with trust in finanshul crisis

    So ther you hav it: EBM in a nutshell. Remember, the futur is brite if you stop squabling and do not fight like Form 3A when master is out of classroom. (Fothering-Thomas, please spelcheck this and send to top medical journal).