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Chris Silagy's death at the early age of 41 is tragic, but sometimes
even obituaries need comment and clarification.
It is reported that he was annoyed at some of the debate about the
merits of evidence based medicine. He was quoted as saying, "When I am
faced with a life threatening decision, I want the best evidence about
whether it will increase my chances, what the side effects are." Knowing
that he had a life-threatening disease, he was not talking theoretically,
but of decisions that he himself had to make. But the quote misrepresents
the debate. Everyone wants the best evidence; the debate centres on the
extent to which evidence drawn from epidemiologically based meta-analysis
and megatrials can be properly applied to individual patients.
In his obituary it was also reported that when Silagy "addressed a
workshop for consumers, they were stunned to discover late in the day that
he was a doctor". I do not know what this means. Are "consumers" patients?
What was it about Silagy's manner or presentation that so stunned his
audience? Those who have followed the debate about evidence based medicine
know that the very choice of the term was provocative. The introduction of
the "new paradigm" (1) of evidence based medicine implied that doctors had
never before used evidence in their decisions, and it allowed enthusiasts
for evidence based medicine to dismiss critics by saying that the critics
were denying the need for evidence. Unless I have misunderstood, the story
about Silagy and the consumer workshop contains a similar implicit
denigration.
Reference
1 Couto JS. Evidence-based medicine: a Kuhnian perspective of a
transvestite non-theory. J Eval Clin Pract 1999;4:267-275.
Chris Silagy's obituary
Chris Silagy's death at the early age of 41 is tragic, but sometimes
even obituaries need comment and clarification.
It is reported that he was annoyed at some of the debate about the
merits of evidence based medicine. He was quoted as saying, "When I am
faced with a life threatening decision, I want the best evidence about
whether it will increase my chances, what the side effects are." Knowing
that he had a life-threatening disease, he was not talking theoretically,
but of decisions that he himself had to make. But the quote misrepresents
the debate. Everyone wants the best evidence; the debate centres on the
extent to which evidence drawn from epidemiologically based meta-analysis
and megatrials can be properly applied to individual patients.
In his obituary it was also reported that when Silagy "addressed a
workshop for consumers, they were stunned to discover late in the day that
he was a doctor". I do not know what this means. Are "consumers" patients?
What was it about Silagy's manner or presentation that so stunned his
audience? Those who have followed the debate about evidence based medicine
know that the very choice of the term was provocative. The introduction of
the "new paradigm" (1) of evidence based medicine implied that doctors had
never before used evidence in their decisions, and it allowed enthusiasts
for evidence based medicine to dismiss critics by saying that the critics
were denying the need for evidence. Unless I have misunderstood, the story
about Silagy and the consumer workshop contains a similar implicit
denigration.
Reference
1 Couto JS. Evidence-based medicine: a Kuhnian perspective of a
transvestite non-theory. J Eval Clin Pract 1999;4:267-275.
Competing interests: No competing interests