Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Ignorance-Based Education

The separation of ignorant, scientifically illiterate people from the ranks of teachers is just as important in medicine.

The ignorance of mythology is not limited to biology. Educators in all of medicine, not just EMS, pass on a lot of mythology as if there were some sort of scientific basis for it – or as if pointing out the lack of evidence for a myth is in some way being unfair to the myth. As if giving dangerous treatments to patients is not bad medicine if our ignorance is based on good intentions.

The road to bad outcomes is paved with good intentions – and ignorance of evidence.

We do not seem to care how many patients are harmed by our treatments, because we believe it is a benign treatment. This is not based on any good evidence. This is based on our wishful thinking.

We act as if anecdotes matter.

We act as if occasionally studied surrogate endpoints are significant.

If I want to give you cyanide, based on my ignorance of the harmful effects of cyanide, but based on my strong belief that cyanide is a good treatment, do you want the wishful thinking-based treatment?

If I want to give you any other treatment, not based on evidence of benefit or evidence of safety, but based on my strong belief that doing something – anything – is better than not doing something, do you want the wishful thinking-based treatment?

The evidence of harm is never enough to convince us, because we demand proof of harm.
 

Why don’t our patients deserve evidence that we are not harming them?
 

Why don’t we get rid of the teachers who encourage us to harm our patients based on ignorance?

We act as if the evidence of benefit is not important, because we just know that the magic treatment works.

Oxygen is always good. We believe in oxygen, so it is always better to give more, just in case. We pretend that the evidence of harm is not to be trusted. We pretend that the lack of evidence of benefit is not important.

We refuse to give large doses of NTG, because what if we bottom out her blood pressure?

So what if the patient can’t breathe?

So what if huge doses of nitrates have repeatedly been demonstrated to be safe?

When did the patient’s life become more important than easing our ignorance-based anxieties?

What if . . . ?

No.

What if we based treatments and assessments on valid evidence?

We need to understand that if something does not work repeatedly in a controlled setting, there is no reason to expect the quackery to work at all in an uncontrolled environment.

We need to understand that our desire to do something (no matter how harmful) is not more important than avoiding doing something harmful (especially something based on wishful thinking)?
 

We need to understand just how dangerous and reckless wishful thinking is.
 

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Comments

  1. Your argument is valid and I agree wholeheartedly, but the logical “next step” to take from this conclusion is not so easy. I’m currently re-writing our system’s protocols, and have spent considerable time searching for protocols to benchmark. Perhaps I haven’t looked in the right places, but I have yet to find evidence-based EMS protocols besides Dalhousie University (http://emergency.medicine.dal.ca/ehsprotocols/protocols/TOC.cfm). I’m certainly not saying that all protocols in my search were void of evidence, only that it isn’t common practice to include a “References” section in protocols for the next person to take that “next step.”

  2. As always, a great article–and in fact, one of the best in a while. It speaks to the heart of what this blog is all about.

  3. http://www.aacti.ca/group.php?group_id=10041

    Richard Poon is working on a program in Alberta.
    http://www.aacti.ca/group.php?group_id=10041&v=project

    Time to bring ems out of the dark ages.