One of the recurring themes of this blog, not surprisingly given its name, is the proper role of science in medicine. As Dr. Novella has made clear from the very beginning, we advocate science-based medicine (SBM), which is what evidence-based medicine (EBM) should be. SBM tries to overcome the shortcomings of EBM by taking into account all the evidence, both scientific and clinical, in deciding what therapies work, what therapies don’t work, and why.
To recap, a major part of our thesis is that EBM, although a step forward over prior dogma-based medical models, ultimately falls short of making medicine as effective as it can be. As currently practiced, EBM appears to worship clinical trial evidence above all else and nearly completely ignores basic science considerations, relegating them to the lowest form of evidence, lower than even small case series. This blind spot has directly contributed to the infiltration of quackery into academic medicine and so-called EBM because in the cases of ridiculously improbable modalities like homeopathy and reiki, deficiencies in how clinical trials are conducted and analyzed can make it appear that these modalities might actually have efficacy. Read more »
*This blog post was originally published at Science-Based Medicine*
Thanks to Harriet Hall, I found this hilarious spoof article from the BMJ which perfectly illustrates why “Evidence-Based Medicine” (EBM) alone is not sufficient for answering medical questions. The abstract perfectly illustrates why randomized controlled trials must be viewed within the context of general scientific knowledge rather than in isolation. The weakness of EBM has been an over-reliance on “methodolatry” – resulting in conclusions made without consideration of prior probability, laws of physics, or plain common sense.
EBM is valuable but not sufficient for drawing accurate conclusions… which is why Steve Novella and the Science Based Medicine team have proposed that our quest for reliable information (upon which to make informed health decisions) should be based on good science rather than EBM alone.
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
Gordon C S Smith, professor1, Jill P Pell, consultant2
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EM at its finest:
Ending a shift with a bang.
I write a nice note trying to capture the essence of what I did and why I did it. Can’t write “decided to go big or go home” so I wrap it up in that nice, sterile and intentionally understated medicalese which makes it seem like the decisions were clear cut, and based on solid information, when the truth is that they were largerly judgement calls based upon spotty and/or inaccurate information.
I sign out and then I punch out.
In EM we often don’t get to wait for the test result, or for a period of observation. Curse, and beauty, of the job.
*This blog post was originally published at GruntDoc*