A slap on the face and a pat on the back are one and the same – a
response and for that I am grateful . I am a great fan of evidence based
medicine and have been involved in peer review and author a chapter in
“Clinical Evidence” . It swept away the old monarchy of the consultant
opinion being law and has done much to standardise and improve care. But
EBM has become increasing authoritarian and now stifling dissent . I
know that many of the interventions I use are questionable but I do
what the evidence dictates.
But it is more fundamental than this for evidence medicine is
flawed in many major ways. No research , no evidence ( commissioning
bias) means only organizations with the resources to sponsor research
have the “evidence” ( Pharma companies in effect ) therefore EBM is
“dominated by therapeutics. This seemingly obvious e fact is never
acknowledged or even discussed. Also, Study population are chosen
because they a are high risk but the research conclusions applied to low
risk population where the benefits are negligible or nil . Consider that
the natural history and epidemiology is not known for many conditions eg
Chamydia, IHD , also trials are short with scant long term follow up
data , the use of surrogate end point is rife and statistical significance
is wrongly equated with clinical significance. I could go on – but
evidence based medicine is not what the clinical propaganda might have us
believe. We need to see the limitation of EBM.
In the real world working doctors don’t submit case report because ,
they have no professional incentive to do so and most consultants and
GPs don't feel that they possess the academic skill or training needed .
Clearly this is something that should be addressed . Also , ethics
committees are impossibly frustrating to deal with and again only well
organise companies with commercial and financial interest have the
resources to get through the mountains of duplicate paper work. I am
unbowed in my criticism of EBM because is becoming as bad be as the rotten
system it replaced. Lastly it is amazing the gems you might find in other
people's rubbish !
Rapid Response:
Restoring a balance
A slap on the face and a pat on the back are one and the same – a
response and for that I am grateful . I am a great fan of evidence based
medicine and have been involved in peer review and author a chapter in
“Clinical Evidence” . It swept away the old monarchy of the consultant
opinion being law and has done much to standardise and improve care. But
EBM has become increasing authoritarian and now stifling dissent . I
know that many of the interventions I use are questionable but I do
what the evidence dictates.
But it is more fundamental than this for evidence medicine is
flawed in many major ways. No research , no evidence ( commissioning
bias) means only organizations with the resources to sponsor research
have the “evidence” ( Pharma companies in effect ) therefore EBM is
“dominated by therapeutics. This seemingly obvious e fact is never
acknowledged or even discussed. Also, Study population are chosen
because they a are high risk but the research conclusions applied to low
risk population where the benefits are negligible or nil . Consider that
the natural history and epidemiology is not known for many conditions eg
Chamydia, IHD , also trials are short with scant long term follow up
data , the use of surrogate end point is rife and statistical significance
is wrongly equated with clinical significance. I could go on – but
evidence based medicine is not what the clinical propaganda might have us
believe. We need to see the limitation of EBM.
In the real world working doctors don’t submit case report because ,
they have no professional incentive to do so and most consultants and
GPs don't feel that they possess the academic skill or training needed .
Clearly this is something that should be addressed . Also , ethics
committees are impossibly frustrating to deal with and again only well
organise companies with commercial and financial interest have the
resources to get through the mountains of duplicate paper work. I am
unbowed in my criticism of EBM because is becoming as bad be as the rotten
system it replaced. Lastly it is amazing the gems you might find in other
people's rubbish !
Competing interests:
None declared
Competing interests: No competing interests