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At 11:00 AM 8/24/2006, Mark Pearson wrote: >I am in agreement with much of what has been said about the Holmes et al >paper - it has a cavalier attitude towards making sweeping statements >based on tenuous evidence, and (problematic though such research may be) >the apparent unwillingness to conduct methodologically rigorous research >on (e.g.) the Cochrane Collaboration does not help their case. Despite all >this, I still think that Michael has a point when he says that "the ideas >aren't that outrageous... any group defines ways of doing things that >excludes others" - maybe this is at the root of the authors' use of the >word 'fascist' - they had gotten fed up not being listened to, and thought >that courting controversy might be the best option for stimulating debate >about the issues concerned (and perhaps it has worked, going by the >postings on this and the Evidence Network mailing lists!) > > > >I would like to ask some of the other members to elaborate a little more >on their postings if possible, in the main because it seems that their >experiences of EBM are so polarized that I have trouble reconciling them. >Roy states that he has found it "hard to get EBM related concepts into >medical education [and] funding for EBM work", whilst Owen states that his >involvement with the education of primary care Doctors and Nurses has been >notable for its production of practitioners who "just want to be told who >to prescribe what to". I think what Owen is getting at here is that >despite EBM's ideal of integrating diverse forms of knowledge (research >evidence, Doctor's experience, patient's values), the effect has been to >produce practitioners unable to think. Yet Roy is concerned that EBM >concepts have not affected the practice of medical education enough! > > Of course, one issue may be differences across countries. Holmes et al were writing in Canada. My experience noted above is mainly in the US. And Mark is writing from the UK. Of course, Holmes et al did not say their comments were meant for one country in particular. See my post on Health Care Renewal (http://hcrenewal.blogspot.com/2006/08/post-modernist-view-evidence-based.html) which includes some references to back up my comments on the penetrance, or lack thereof of EBM into US medical education. Roy M. Poses MD Clinical Associate Professor Brown University School of Medicine <[log in to unmask]>