Views & Reviews From the Frontline

Evidence based medicine is broken

BMJ 2014; 348 doi: (Published 03 January 2014) Cite this as: BMJ 2014;348:g22

Re: Evidence based medicine is broken

Evidence based medicine is not broken, as suggested (1). It’s just out of date.

Evidence based medicine is a 20th century approach to medicine, using 17th century scientific ideas (2,3). It is the best available for its time, with many attributes and limitations, but requiring a translation factor to apply to reality and to the individual.

Complexity based medicine is a 21st century update, a more holistic neoHippocratic approach to medicine, which recognizes a web of dynamic interactions, causation and relations, with features like uncertainty, emergence and context that impact health and wellbeing (2-3).

Evidence reflects the science of its day and is in the eye of the beholder (2-3). Stephen Hawking suggests that complexity will be the science of the 21st century. It should thus apply to medicine and health, and complexity could be the translation factor required.

Medicine and health practitioners work at the edge of chaos, a creative zone of complexity and reality between order and chaos (as disorder), interpreting and using evidence in context, consciously or unconsciously considering influences from the web of interactions (2-4).

Complexity based medicine reflects evidence based medicine in context, allowing us to understand and translate evidence to reality, with all its glory and flaws, and allow identification of concerns like those raised (1,2).

Evidence Based Medicine is not broken, just out of date, and could be brought to the 21st century with the 21st century science of complexity, at the edge of chaos (2-4).

1) Spence D. Evidence based medicine is broken. BMJ 2014;348:g22

2) Rambihar VS. A New Chaos Based Medicine beyond 2000: the response to evidence. Toronto Vashna Publications 1999.

3) Rambihar VS. Science, evidence and the use of the word scientific. Lancet 2000;355:1730.

4) Plsek P, Greenhalgh T. The challenge of complexity in health care. BMJ 2001;323:625-8.

Competing interests: Graduated from McMaster University Medical School, home of evidence based medicine and in my opinion, a complexity based medical school.

16 January 2014
Vivian S Rambihar
Adjunct Assistant Professor Medicine and cardiologist
University of Toronto
3000 Lawrence E, Suite 3302, Toronto M1P2V1