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Hi there! Yes, I see what you mean. For me, the problem is partly that I
think in this instance - EBM -  "EBM" isn't a thing at all: it's more like
a statement "music is a good thing and it should be one of the things that
people consider when they want to be entertained, distracted or affected"
and the adherents of that philosophy.

If you try to separate "it" from the practices/actions/priorities it is
encouraging, then I don't think there is any "thing" left. It becomes only
a vague statement of belief - something like "the best evidence should be
considered along with other things" where the meaning of the component
words/phrases is interpreted differently/contested anyway. Embedded in the
notion are things like "there should be more rationality and probabilistic
thinking rather than going with the gut/(manipulated) flow in medicine".
And "effects matter and things should be rigorously evaluated and those
evaluations should influence what happens next." And of course, even
without the articulation of something called EBM, those things existed. EBM
then is characterized by its particular "things" - in particular, the
systematic review, the trial, probabilistic statistics.

What there is, is a lobby/community for particular types of changes to
health research, health information, healthcare practice, health
regulation/payment, health professional education etc, and the
interventions being promoted that would make these things different to the
way they would have been without a lobby for those changes. And if that
lobby rallying around those changes that people want to see (very loosely
categorized as "believing in EBM") hadn't existed, we would be better or
worse off or no different, in different ways.

Tried not to use the word paradigm, but really, isn't that what's left
about what "EBM" is, if it's not its interventions and its lobby/community?
This thing formed, but other things would have emerged if this hadn't
existed. Maybe it's neither music nor performance: it's a kind of "rules"
for musicians and audience, and its school of adherents, perhaps.

Hilda


On Fri, May 10, 2013 at 4:54 AM, Michael Power <[log in to unmask]>wrote:

> Thanks Amy and Hilda
>
> I was trying to clarify the difference between evidence on "the effects of
> EBM systems" and evidence on "EBM".
>
> To use a musical analogy, this is the difference between evaluating a
> performance and evaluating the music - hitting headlines this morning is
> the cancellation of a new production of Richard Wagner's Tannhauser. The
> problem was not with the music, but with the Nazi overtones in the
> production.
>
> Critics of EBM point out problems with the performance and make it seem
> that there are problems with the music - examples available on request.
>
> There is a similar problem with defining and explaining EBM. If you define
> or evaluate EBM by outcomes or applications, you are assuming that the
> performance IS the music. How will you improve your performance or develop
> a totally new production for your show?
>
> Changing the metaphor, I prefer to think of EBM more as a journey guided
> by the aspiration to make optimal decisions (our fixed star) than an
> itinerary with route and destinations that must continually evolve even if
> they were initially predefined.
>
> Michael
>
>