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

- Rogue Medic

How do you feel about Evidence-Based Medicine? Part II

Continuing from Part I, examining some of the claims made by people who do not like EBM (Evidence-Based Medicine) even though they do not appear to have taken the time to find out what EBM is.

Here is another of the claims made in the comments of Medscape‘s physician-only discussion of EBM (Evidence-Based Medicine) and SBM (Science-Based Medicine).[1]

Find a paper that says one thing, and I will find another that refutes[2]

Evidence is probabilistic, so there is the possibility probability that there will be partially conflicting results. The higher the quality of the study, the less likely that there will be a similar study that contradicts it.

Expert opinion does not do so well.

Given six experts, should we expect only six opinions, or many more?

If we open it up to experience, then we can find hundreds, maybe thousands, of experience-based opinions.

Just because something happened after something was given does not mean that there is any cause and effect relationship. This is the well known post hoc, ergo propter hoc fallacy – after the fact, therefore because of the fact.[3]

After we brought your mother to the hospital, you were born. Therefore, you were made in the hospital. After I used the rotating tourniquets, the patient began to breathe better, therefore the rotating tourniquets made the patient breathe better.

Are these reasonable beliefs?

No, but according to these opponents of EBM, we should not expect them to pay attention to the evidence that these conclusions are misguided.

They are experts. The evidence MUST be wrong.

But no doctor would believe that hospitals make babies!

Doctors believe many equal crazy things.
 

Once we abandon evidence, there is no limit to how ridiculous expert opinions can be.
 

If we include intuition, the number of intuition-based expert opinions becomes infinite.

What could possibly limit opinions that are based on intuition?

Expert opinion is the lowest level of evidence, but many experts do not understand that. This is one of the reasons their opinions are of so little importance.

Science alone of all the subjects contains within itself the lesson of the danger of belief in the infallibility of the greatest teachers in the preceding generation … Learn from science that you must doubt the experts. As a matter of fact, I can also define science another way:

Science is the belief in the ignorance of experts. – Richard Feynman.

Faith in expert opinion is the belief in the ignorance of science and the belief that the rare coincidental improvement of occasional patients justifies abusing all patients with treatments that cannot be demonstrated to work.

I don’t have to prove that it works, because I’m an expert. You have to prove that it doesn’t work!

 


 

Should our patients have to suffer, and die, to protect the egos of these well-intentioned, but ignorant doctors?

We should limit wishful thinking-based unproven treatments to controlled studies.

To be continued in Part III.

Footnotes:

[1] How do you feel about Evidence-Based Medicine?
Medscape
Article

[2] “How do you feel about Evidence-Based Medicine?”
Dr. Harriet Hall
May 29, 2012
Science-Based Medicine
Article

[3] Post hoc ergo propter hoc
Wikipedia
Article

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Comments

  1. Expert opinion should be based on data and analysis. Knowledge of pathophysiology and the effects of interventions. That includes EBM. That does not mean that the expert is right – only that he is making the best decision based on how the patient presents and an extensive knowledge of treatments (including well designed research). As the medical community learns more through research, the expert opinion should change to reflect the new information.

  2. From reading the blog (couldn’t access the Medscape discussion), it seems that there are two things with the same name. The first, evidence based medicine, is simply ensuring that medical treatments are supported by scientific controlled studies to ensure they work. On the other hand, there seems to be something called Evidence Based Medicine, which is a poor attempt to implement the former idea, and is mandated by non-clinical administrators with no understanding what the idea means or how science works.

    Those administrators may find the one paper that supports their personal biases (remember the papers you critiqued on the Rad-57 CO detector?) and force clinicians who know better to follow that particular “evidence”. If I had to deal with that sort of implementation, I’d probably hate the acronym EBM as well.

    Science is a wonderful tool; but like any tool, it’s only as good as the person using it.

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