Who examines evidence?

The case for evidence based medicine is strong. Some 50 years ago, teaching medical students was based on the experience of Very Senior Clinicians who wrote or edited medical textbooks. But if you read a textbook published just 20 years ago, you will find statements that we now know are seriously untrue. If a Very Senior Clinician asserted, in one edition of his or her textbook, that treatment X was the best choice for condition Y, this tended to persist in subsequent editions unless strong evidence to the contrary was discovered. Today, the gurus pronouncing on the efficacy of treatments are no longer senior clinicians, but Omniscient Meta-analysts. These serious minded people may have little personal experience of treating condition Y, but they diligently seek out every randomised controlled trial of available treatments, and by combining all this information may decide that treatment Z is even better than orthodox treatment X. Evidence based medicine involves accepting guidance from meta-analysts, rather than clinicians, which is …