Before you decide that this critique of Evidence-Based Medicine is misguided and ill-conceived, ask yourself the following questions. If you answer any of them in the affirmative, then I believe that you will find this website illuminating.
- When you are filling out a survey or questionnaire do you ever feel that the answer scales provided do not really capture your true response? That they just don’t really feel right? That your response is being manufactured to fit the scale and not vice-versa?
- Have you ever wondered why it is that some medical treatments and care seem to come and go, almost more like fads than science? Why one year hormone replacement therapy is all the rage and a few years later it is no longer acceptable? One year mammograms save lives, the next year, they no longer save lives.
- Do you often come out of evidence-based discussions more confused then when you went in?
- Do you ever have the feeling that evidence seems to come and go, almost like fashion?
- Do you ever wonder why there are such huge discrepancies in medical literature? (e.g., a given treatment is 15% effective in some institutions and 85% effective in others).
- Do you ever wonder why you frequently discount studies carried out in other countries, and why the results of some research from other cultures just seem bizarre, almost preposterous?
- Do you ever wonder why you are unconvinced by industry-sponsored research, even though it appears to be sound?
- Do you ever ask yourself the question: If medical research is so scientific, why is disclosure of potential conflicts of interest so important when presenting or publishing research?
- Do you sometimes feel like Evidence-based reviews are sort of like liver or spinach: you don’t really like them, but you try to read them because they are supposedly good for you?
- Do you ever feel that RCTs (Randomized Controlled Trials) are not really suited to study many of the questions we have in medicine, but we do them anyway.
- Have you ever had the transient thought that many of instruments we use to do research in Medicine, such as QALYs (Quality Adjusted Life Years) or QoL scores (Quality of Life) are actually crude and primitive, but quickly banished the thought, because all those really smart people in clinical epidemiology seem to think they are helpful?
- Do you ever feel that a lot of evidence just does not capture the nuances of your medical practice?
- Do you ever worry that colleagues will consider you an idiot if you do things that are not “evidence-based”
- Do you ever feel like you have to toe the line about all this EBM stuff, otherwise your colleagues will consider you a Luddite?
- Do you ever long for the days when you didn’t have to justify your decisions based on the latest evidence?
- Do you ever fantasize about retiring and not having to try to learn all this EBM stuff?
- Do you ever, fleetingly, wonder whether EBM really helps patients; but you then banish the thought from your head, because it must be foolish?
- Do you ever feel that arguing about evidence is futile, that we frequently just use evidence to justify our beliefs and discount it when it does not suit our purposes?
- Have you ever wondered why you are not convinced by some studies, even though they appear well conducted?
- Have you ever thought, “I wouldn’t believe this research, even if it were true?”
As I said above, if you have answered in the affirmative to any of these questions, I think you will find this website and discussion illuminating.