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In a phrase:
Evidence-Based Medicine (EBM).
It was my engagement (or rather, lack of engagement) with the advocates of EBM that first made me realize that most of the intellectual leaders in modernity are simply unable to understand the issues which they claim to dispute.
These writings summarize my activities in relation to EBM
http://www.hedweb.com/bgcharlton/journalism/ebm.html
http://charltonteaching.blogspot.co.uk/2009/08/zombie-science-of-evidence-based.html
The term 'over-promoted incompetent' applies to pretty much all of the EBM advocates I came in 'contact' with, either in conversation or in correspondence - although in my judgement the primary leader of the movement was dishonest rather than incompetent.
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I know very little about Evidence-based medicine, but I recoil instinctively from its name, which seems to claim a monopoly over using evidence. Surely that's implausible?
ReplyDeleteI shall now hie off to see what you have had to say on the subject.
"a self-styled ‘group of rebels’": then it's odds on that they are a parcel of rogues.
ReplyDelete"a Zombie science": alas, I have to tell you that I have a rule never to read on once I have encountered the word "zombie".
ReplyDelete@d - It is a good rule - IN GENERAL...
ReplyDeleteWell, Thanks Bruce.
ReplyDeleteEBM, for those who do not know, is the use of critical appraisal and meta analytic techniques to review research evidence and use that to make informed decisions about what to do.
Most of my academic reputation is based on EBM -- it is where I started (I'm in Clinical Evidence and in Cochrane, Bruce).
But in medicine, there is a point where the evidence runs out. Where there will never be a research protocol, because the circumstances are rare, the studies will not be funded, and the mechanical application (doing meta analysis is like feeding an organ grinder. You need to be able to follow a cookbook. It is not the work of genii).
I'm not sure, Bruce, if the UK NHS gets that point. NICE seems to distort the data to meet economic and political ends.
Most of the time, if a person's condition is responding to treatment by guideline, I don't see them. I'm a consultant psychiatrist: I currently run an inpatient ward. If it is not difficult and dangerous... GPs (at least in NZ) with the community teams can deal with it.
I will rant about the uselessness of the current outcome measures (HoNOS) and risk assessment at another time.
@Chris - My paper with Andrew Miles, The Rise and Fall of EBM, is the most cited thing I have written (for all the good it did!) -
ReplyDeletehttp://qjmed.oxfordjournals.org/content/91/5/371.full.pdf+html?sid=f0386ae5-2476-4404-ad24-91385e3d80a9