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Alternatives to evidence based medicine

BMJ 2000; 321 doi: (Published 22 July 2000) Cite this as: BMJ 2000;321:239

Propaganda based medicine is an alternative …

  1. Aldo Mariotto, head (
  1. Unit for Technology Assessment and Quality Assurance, ULLS 16, 35100 Padua, Italy
  2. University of Washington, Harborview Medical Center, Seattle, WA 98040, USA
  3. University of Virginia, Neurology 394, Charlottesville, VA 22908, USA

    EDITOR—Isaacs and Fitzgerald's short paper on alternatives to evidence based medicine seems to establish a new classification in the art of medicine.1 I would like to make a small but practical nosological contribution.

    Eminence based, eloquence based, and confidence based medicine could be grouped into the single entity narrative based medicine (a term borrowed from Carlo Favaretti). Notwithstanding the fact that each of these individual disciplines has a longstanding tradition, their strong chat based rather than fact based component makes them similar enough to justify the suggested aggregation.

    Although the authors skilfully depict the consensus and decision making processes that are adopted in practice, I believe, however, that they have ignored a commonly used eighth alternative—namely, propaganda based medicine.

    If doctors have only a limited amount of time for scientific training, if they swallow anything they are told, or if they find themselves in any other unmentionable circumstance they may fall prey to pharmaceutical representatives with the best strategies for physician-changing behaviour. In clinical practice the markers for the two types of propaganda based medicine are (a) gullibility and (b) unexplainable …

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