Barely a quarter of medicine is evidence-based

Businessweek profiles Dr. David Eddy, an evidence-based medicine crusader.

Comments are moderated before they are published. Please read the comment policy.

  • Gasman

    Ironically, there is no evidence that evidence based medicine is more effective than what it aims to replace.

    It’s kind of like “No child left behind”, and all other “it’s for the children” sort of programs. How can anyone be against children; how can anyone be against evidence. We all use evidences, from textbooks, articles, medical conferences and other sources to continually stay up to date. The plain old practice of medicine is evidence based. What the EBM guys want to do is make every clinical situation cut and dried. Got hypertension, then use the EBM guidelines to initiate therapy. Problem is EBM is rapidly becomming a benchmark for practice for which rational differences in practice end up as a black mark on the docs record. My internist wanted to start an antihypertensive for me. I already had him stumped because I don’t smoke, my BMI is 26 and I cycle 100 miles per week. He’s rigidly fixated on beta-blockers and I don’t even need a trial of this to know that it will whack my performance something fierce. Clonidine or ACE inhibitor might be more rational first drugs but his EBM guidelines won’t permit it. This is the problem with EBM. It is great at determining the best choice for a population when no specific details are known. But once you know some specifics about the patient in question then the doc is supposed to use some medical knowlege along with the medical history to treat a patient, not a population. So I’ll ask again, where is the EBM for EBM?

  • Anonymous

    More hot air from the gasman–of the sort that makes me wonder whether he has a scientific training. Of course, EBM–at this stage–cannot provide protocols for every combination of disease/symptoms. One day, perhaps, there will be studies of hypertensives with low BMIs who brag about all of the aerobic exercise they do. And, I don’t think even EBM’s strongest advocates would argue for robotic application of rules in the face of confounding evidence.

    You’re simply wrong to say that all doctors use evidence. “the plain old practice of medicne is evidence based” Ha, ha, ha!!! I bet your predecessors in th 17th Century were convincned that in their experience bleeding was highly effective! Doctors are either too stupid or too arrogant to recognize how the power of psychological confirmation bias, as well as their own professional need to market effective treatments, clouds their empirical judgment.

    Evidence means, at best, laboratory work. Second best, controlled randomized studies, Third best, all the other stuff with various statistical safegards. To confuse the issue is fraudulent.

  • Anonymous

    “Doctors are either too stupid or too arrogant to recognize how the power of psychological confirmation bias, as well as their own professional need to market effective treatments, clouds their empirical judgment.”

    Oh you silver-tongued devil! I bet your powers of gentle persuasion have made you lots of friends and followers.

    Your abrasive and repetetive insults undo any powers you have to persuade once again–never mind the fact that they are as illogical and biased as anything you “argue” against.

    Doctors are all too arrogant and stupid. That must be the answer.

    What a silly abrasive fool.