Before responding to questions and objections, let me summarize my argument here. I have argued that the entire edifice of Evidence-Based Medicine is premised on what I call the “fallacy of quantification”: that is, the fundamental assumption that that medical phenomena (e.g., burden of disease, degree of disability, response to treatment, extent of symptoms) can be quantified to permit measurement. This assumption is so basic, so foundational to the enterprise of EBM that it is almost never acknowledged, let alone called into questioned. And I have argued that the process of quantification (that is, the process of giving numerical values to complex qualitative medical phenomena), creates a facade, a veneer of objectivity, which glosses over the intrinsic subjectivity of clinical research. And I have shown how the “fallacy of quantification” distorts and misrepresents medical phenomena and leads not just to misleading and unreliable research outcomes, but frequently to inconsistent and bizarre ones. And finally, I have argued that once we have lifted the specious veil of objectivity which surrounds Evidence-based Medicine, it is clear that any medical advances we have made in the past 20 years are not because of EBM, but rather in spite of it.
I realize that this is a provocative and controversial argument. And it is undoubtedly threatening and offensive to many people who have invested much time and energy in the pursuit of EBM. I also realize that there are many people who will not be convinced by my argument. In fact, I think that unless one already harbours significant doubts about utility and truth of EBM, one will not necessarily be convinced by my argument. That said, I do believe that a great many physicians secretly entertain doubts and suspicions about the benefits of EBM, but are reluctant to voice concerns for several reasons. First, they are fearful of being considered a fool and a luddite. Second, they don’t fully understand why EBM does not appear to work. And third, they are intimidated by the fact that no end of prominent people, Journals, and Institutions thoroughly endorse it. My hope here is to give voice to what I suspect is a large silent majority.
So, let me know respond to some of the most common questions and objections
- Consequences of your Argument
- Are you serious?
- What about the impact of good research?
- EBM is just a tool for evaluation and interpretation
- What about bias in research?
- What do you propose?
- Concluding remarks