> June 1 2001 ("rabbits!")
>
> I believe that you are referring to an article under that or
> a very similar title by Dr. Geoff Norman at McMaster
> University, published I believe in the mid '90's.
>
> I agree that EBM use, teaching of its use, and adoption of
> its methods are not the same thing as achieving longer or
> better quality of life (subject to the definition of the
> latter). There is excellent evidence from Kahneman, Tversky
> and others that human decision making given uncertainty is
> irrational, and lots of evidence elsewhere that unsupportable
> but habitual interventions persist, and that effective ones
> are adopted slowly at best.
>
> There are other relevant questions as well that have not been
> addressed in evaluating the EBM effect, whatever it is. One
> is whether the appropriate outcome measures have been sought.
> Another is whether they have been sought for long enough. The
> list goes on.
>
> Perhaps the human species has become relatively resistent to
> ineffective interventions, and somehow survives despite most
> of them. Someone - I would love to know who - said "Life is
> too short to drink bad wine." Perhaps critical appraisal, or
> as Norman once called it "CRAPP DETECTION" and EBM are
> methods to assess whether the wine is good or bad, before drinking it.
>
> Sincerely,
> Phil . Hall
> Maternal & Fetal Medicine
> University of Manitoba
> Winnipeg, Manitoba, Canada
>
> >>>My take on this SR was that is why this list has been
> relatively quiet, of
> late. Two years ago, when I joined, there would at least be
> 2-3 posts per
> day. Now the volume appears less to me. I have no doubt
> right now that all
> we can say about EBM is that it can make practices more
> evidence-based.
> Helping patients live longer or with better quality of life
> is an entirely
> different matter. I remember seeing an excellent article
> (but now have
> lost the reference) titled something like "A Critical
> Appraisal of Critical
> Appraisal". It wasn't kind to EBM, and really spoke to the
> need for the
> questions brought up by these posts.
>
> I think EBM is good, even if all it does is make practice more
> evidence-based. I think patients deserve therapies that have some
> foundation, as opposed to tradition or whimsy. I think this
> is why we will
> see EBM evolve along with reflective practice to create an
> environment,
> where science and art can compliment one another.
>
> Dan Sontheimer
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