ADRIAN ROBERTS wrote:
> I recently ran one of a series of workshops for general practitioner
>
> registrars, on aspects of EBM. They were intelligent and receptive and it
> appeared to have gone well. However, I was intrigued by a
> conversation at
> lunch when one of the participants was earnestly and seriously
> recommending
> that her friend should try a particular herbal remedy for her ailment.
> The
> justification was, "It cleared my problem up really quickly." It
> demonstrated that the messages of that day and of previous sessions
> had not
> really got through. There was still the uncritical acceptance of
> anecdote as
> a basis for decision making, the failure to distinguish Necessary from
> Sufficient evidence, not to mention the lack of awareness of the
> problem of
> uncommon serious adverse effects and the difficulty of knowing the
> probability of these. The latter had been dealt with in an exercise about
> the use of new drugs and risks of uncommon side effects; Hanley's Rule
> of 3
> had been discussed.
>
> [snip]
>
> Do others have these thoughts and reservations?
>
> Do the many more experienced teachers of EBM on this list include some
> basic
> epistemology in their teaching?
>
>
Your overheard comment was a valuable insight into people. You might
well wonder at the source of your own reaction ("how can apparently
intelligent people still believe in herbal medicine after a whole
morning of my teaching?"). Why is it important to us to promote EBM as a
moral imperative?
One important point in teaching EBM is that there is no moral reason why
someone has to base their belief upon evidence. The concept of truth
inherent in EBM is only one of many. We hold ethical and spiritual
values which we believe to be true, for instance, and we do not base our
ideas of their truth on evidence.
People do not use a single criterion of truth in all situations. Rather,
our criteria for truth vary by context. Interacting with a GP, a person
may well ask about side effects, evidence for treatment efficacy etc.
The same person, hour later, may be told by the assistant in the health
food shop that evening primrose oil is good for removing toxins from the
liver. They will not ask the sorts of questions you expect (what sort of
toxins, how does it work, where is the evidence that it is safe). And
when you meet your true love, you don't need a controlled trial.
EBM is not true because it is based on evidence. Rather, it is the use
of a definition of truth that is based on evidence that makes EBM
different. So EBM does not define what is true; it is the definition of
what is truth that defines EBM. Other systems of truth exist, and are of
value to us all in our daily lives.
This is the basic epistemology that I include in my teaching.
--
Ronan M Conroy ([log in to unmask])
Senior Lecturer in Biostatistics
Royal College of Surgeons
Dublin 2, Ireland
+353 1 402 2431 (fax 2764)
--------------------
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