Does EBM-speak endanger common sense?
Example 1.
"Use a 21-guage needle (green) in women who weigh more than 90kg."
This recommendation is appropriate for a brainless robot.
In plain English, the common sense recommendation for a thinking human
would be "Use an adequately long needle if you have to give an
intramuscular injection through a thick layer of adipose tissue."
Example 2.
"We don't know if other osmotic laxatives such as magnesium salts , or
phosphate or sodium citrate enemas are effective."
There is a simple cure for this piece of ignorance: take a dose of epsom
salts and see what happens. Or, submit a grant application for a
doubleblind, placebo controlled RCT.
Example 3.
"Macrogol 3350 26 g daily was significantly more effective than
20 g lactulose daily".
In practice, the dose of a laxative is adjusted to achieve the desired
effect. So, comparing fixed doses of different laxatives provides
information that is more likely to be useful for marketing than for the
patient or practitioner. Most of the evidence on laxatives is at this
level.
If you have any other examples where common sense has been sacrificed to
the form of EBM-speak, please send them to me. I am building a collection.
Thoughts on the aetiology and treatment of hypocommonsentia would also be
welcome.
Michael Power
Clinical Knowledge Author, Guideline Developer and Informatician
Clinical Knowledge Summaries Service www.cks.library.nhs.uk
Sowerby Centre for Health Informatics at Newcastle Ltd www.schin.co.uk
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