Let me attempt a response to Owen Dempsey. But I don't think a
line-by-line tit-for-tat would be productive. Instead, let me try to
fairly summarize the issues he raised, and respond to each, briefly.
Dempsey Issue 1- In the UK at least, edicts from the government, and other
interested parties, are often cloaked in the mantle of EBM. Such edicts
may not be in the best interests of patients.
My comment: I am hardly an expert on the situation in the UK (and the
Goldenberg article was written in the US.) But in the US, the EBM label
has often been hi-jacked by those with vested interests, here more often
commercial firms. So the problem of people trying to advance their vested
interests, financial or ideological, cloaked under the EBM mantle, I agree
is very real. But is EBM, or its supporters, to blame for those who
falsely assume the EBM mantle? I would argue not.
Dempsey Issue 2- True EBM (which I will quickly try to define as: trying
to apply the findings of clinical research, broadly defined, skeptically
reviewed, systematically searched, to improve patient care, taking into
account clinical experience, the clinical context, and patients' values, or
pick one of the better definitions in the literature) can always be
improved, and should be able to withstand and improve from external
criticism.
My comment: I completely agree.
Dempsey Issue 3- I have snidely disparaged an article which attempted to
make constructive criticisms of true EBM. My use of terms like "whack,"
"accusations," and "diatribe" was emotional and disrespectful.
My comment: Here is where we disagree. I believe that the Goldenberg
article, after my now repeated readings, used a skewed definition of EBM,
layered on criticisms that depended on logical fallacies and appeals to
dubiously relevant authorities, and which were worded so opaquely as to be
nearly incomprehensible to attack EBM as something that would "harm
women." I would ask Dr Dempsey to read the Goldenberg article again, and
re-assess my criticisms of it. If he can show me how the article exhibited
clear understanding of EBM, made its own arguments clearly, logically and
based on evidence, and finally made well-justified criticisms of EBM, I
will be happy to stand corrected. But having read the article twice, I
don't think he will be able to do so. If not, I don't think that an
article in a reputable, peer-reviewed journal that attacks EBM as something
that can "harm women," should stand without criticism.
At 05:20 PM 11/29/2006, Owen Dempsey wrote:
>Dr Poses,
>
>Interesting mailing, if abrasive, closed, and narrow. EBM in reality is
>not taking into account 'experience' or context etc, at least not in UK
>primary care. We do need to take a more objective view of EBM, as it is
>being practiced, and abused.
>
>[snip]
>
Roy M. Poses MD
Clinical Associate Professor
Brown University School of Medicine
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