If, as I mentioned in the previous section EBM and Geocentism, Evidence-based medicine is based on a fundamental misconception, a misleading assumption, then one of the consequences is that we should encounter a large number of anomalous outcomes and results as part of the practice of EBM. And indeed, like Geocentrism, there is not shortage of strange, inconsistent, anomalous results. But we have become inured to the vicissitudes of clinical research and practice that we hardly recognize the bizarreness and inconsistency of much of the results
For example, as I mentioned in an earlier section, I am often surprised by the general lack of enthusiasm which many of my colleagues display for EBM. In fact, when I ask my colleagues whether they practice EBM, it is remarkable how few answer in the affirmative. The most typical responses have an almost apologetic tone and run something like:
Well, I try to, ..…but it doesn’t always apply in my practice….
…it’s very tough, because I have very complex patients”
Well, sort of, …but there’s just no good evidence for a lot of what I encounter”.
In fact, in all the times I’ve posed this question, I’ve yet to encounter a colleague who answered with an unequivocal “Yes”. Admittedly, this is just anecdotal evidence, but I suspect that most people reading this will be nodding their heads in agreement.
Why should this be the case? Why should people have trouble practicing EBM? Given that EBM is simply “the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients”, it seems strange that there is reticence on the part of physicians to acknowledge it in their practice. Surely there are aspects of EBM, which apply to parts of any practice, even if the patients are particularly complex? The explanation that there is “just no good evidence for a lot of what I encounter” is equally puzzling. EBM does not specify that the evidence must be perfect, or even good, for that matter. It says only that practitioners should use the “current best evidence”. Are the physicians who respond with such ambivalence just lazy? Too busy to read the literature? Are they unable to read or interpret the literature, but afraid to admit it? Are they practicing EBM without realizing it?
Or are these physicians telling us something else? Something entirely different? Could it be that they are telling us that there is a disconnect between their practice and the literature? And if so, what sort of disconnect?
This, I would suggest, is the first of many “inconsistencies” with regard to the practice of EBM: namely, the fact that despite its predominance in how medicine is supposed to be taught, learned and practiced, there are surprisingly few physicians who can or will acknowledge that they actually practice EBM. Admittedly, there are several possible explanations for this, and this is just anecdotal evidence (not very high on the level of reliable evidence), but let us just acknowledge this as we embark on our discussion of the inconsistencies of EBM that this is one little odd finding.
In the following sections I’d like to discuss some examples of unusual and strange research outcomes. As I mentioned above, such anomalous outcomes are so common, so typical that we often do not actually regard them as anomalous. But I’d like to take a look from a fresh perspective, to see them in a new light. And these are but a few of the thousands, indeed tens of thousands of such anomalous results. But I believe that once you start to see them again, you will recognize these sorts of findings all over EBM and clinical research.