Dear Amit,
Sometimes "a critical look clears the issue", but sometimes it does not. Revealed truths have a tendency to become entrenched, particularly if they are convenient. Otherwise I concur with your points. "The evidence is the evidence", as has been stated defensively by at least one randomized trialist whose study was criticized, missing the point that it was not the evidence that was challenged as opposed to its interpretation. Add that widespread tendency you cite to seek simplfication of complex issues and "EBM" has the potential to become "reductio ad absurdem", but with devastating results. It is not "EBM" that is the problem - rather human behaviour.
There are at least two randomized trials in obstetrics whose sweeping "one size fits all" conclusions have been re-examined and seriously questioned, but the equally sweeping practice changes that resulted rapidly from those studies' recommendatioins remain. As Sir William Stephenson (Churchill's "Intrepid") once said, "Nothing deceives like a document", and as Omar Khayyam wrote in his Rubayat, "The Moving Finger writes; and, having writ, Moves on: nor all your Piety nor Wit
Shall lure it back to cancel half a Line, Nor all your Tears wash out a Word of it."
Phil. Hall
Winnipeg
Philip F. Hall, MD BScMed FRCSC
Professor, Faculty of Medicine, University of Manitoba
Director, Fetal Assessment & Manitoba Obstetric Outreach and Maternal-Fetal Medicine Programs
Past President of Medical Staff
St.Boniface General Hospital, 409 Tache Avenue D2044
Winnipeg, Manitoba, Canada R2H 2A6
ph 204-237-2547 FAX 204-233-1751
(Past Chair, Obs & Gyn Specialty Committee,
Royal College of Physicians & Surgeons of Canada)
<www.umanitoba.ca/womens_health>
>>> "Ghosh, Amit K. M.D." <[log in to unmask]> 16/02/2007 6:52 am >>>
Dear Prof. Kunz,
Many thanks for sharing this article. Out of all the innovations in Medicine, without fail EBM has been the largest one. I love the critics who point what evidence based medicine is and isn't , as it only makes the expert of EBM take a hard look and re-examine its claims.In any case the whole process makes EBM even stronger.
However in practice many physicians have fatigue from too much EBM and would want evidence delivered in a nicely packaged form. Simple, clear like the article in Time magazine.
The responsibility of writing a clear and simple form to deliver a complex message is huge and it is here where things go wrong and the packaging of evidence is held at fault.Very often the packaging of evidence is confused for the evidence itself and guides the vigor of the critics criticism.EBM gets blamed for these kind of lapses but eventually a critical look does clear the issue.
A healthy dialogue always helps and these days even the critics of EBM have started to cite' evidence' why EBM could be named something else!
Amit Ghosh
Dept of Medicine
Mayo Clinic
Rochester, Minnesota.
USA 55905
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