Well done Neal and colleagues. Nothing to disagree with. However, I found the following sentence a key to the possibility of resolving the dilemmas identified in your paper ("Evidence based medicine: a movement in crisis?")
"Given that real evidence based medicine is as much about when to ignore or over-ride guidelines as how to follow them, those who write guidelines should flag up the need for judgment and informed, shared decision making."
This really bring us back to the seminal 1992 JAMA paper, which introduced EBM and highlighted the role of experts (and nature of expertise); should we trust experts with their tacit knowledge based on private evidence not accessible to others, or should we insist on explicit, public type of knowledge that can be understood by all people who share a common set of the tools (and values)? The public scrutiny and demand for accountability currently heavily favors "rules" over "judgments" .... I am skeptical that we will see fundamental changes any time soon even if successfully enact all initiatives outlined in Box 3 of the paper...
This, of course, is not to say that we should not try, but as they say "it is complicated":)
Best
ben
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Neal Maskrey
Sent: Friday, June 13, 2014 2:16 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: RealEBM paper
http://www.bmj.com/content/348/bmj.g3725
Trish is up a mountain so I'll post that this is published online in the BMJ today.
The amazing Trish G who led all this magnificently, lots of big brains..........and little me.
The BMJ seems to have website problems today; I can only get this via Explorer and not on the iPad (yet?). Be gentle dear friends, be gentle.
And of course, thanks as ever for all the stimulation............
Best to all
Neal
Professor Neal Maskrey
Consultant Clinical Adviser, Medicines and Prescribing Centre
National Institute for Health and Care Excellence
Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BT | United Kingdom
Tel: 07770535128
Visiting Professor of Evidence-informed decision making, Keele University, Staffordshire. ST5 5BG
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