There is an old saying that 86% of all statistics are made up on the spot. And there is the famous Churchill quip that there are lies, damn lies..and then there are statistics. Both of these comments highlight the sense most of us have about the inherent unreliability of most statistical information. But we rarely delve deeper to try to understand why that is the case.
If you have read through this website from the welcome page, you will recall that I told you my conclusion right at the outset. I said that I am firmly of the belief that EBM is a misguided and ineffectual enterprise and that advances and improvements in medical care over the past several decades have not occurred because of EBM, but rather in spite of it. As I said then, I really mean this. And I hope you are beginning to understand now. Given the distortion and misrepresentation inherent in the process of quantification, it is no wonder that we get such bizarre and anomalous research results. And it is no wonder that most physicians harbour deep, but often unarticulated reservations about the entire EBM enterprise. In fact, when you really think about it, it is remarkable that we have made any progress in patient care at all. That is why I believe that advances and improvements in medical care over the past several decades have not occured because of EBM, but rather in spite of it.
Now, make no mistake, I do believe that we have made significant advances in medical care. I do believe that surgical procedures have improved, that we have better chemotherapy, that cardiac stents work, that DVT prophylaxis saves lives. I just don’t think it is because of EBM or anything related to it. I think it is because when it comes to caring for patients, common sense tends to prevail and physicians ignore most of the nonsensical research. If you ask a bunch of physicians, even those at Universities, whether they practice EBM, you will be surprised by the responses. Nobody ever says “yes I do”. Instead they say things like “I try to…but there’s not a lot of good evidence in my area….” or “Well, sort of… but it doesn’t always apply to my patient population” or “its tough… because patients are very different” . What physicians are really saying above is that EBM just does not really reflect the real world of medical practice, that it just doesn’t work. So, to be clear, I do believe that we have made improvements in patient care, but I am sure that it is in spite of the evidence-based medical movement.
Now, if you are puzzled and perhaps a little confused, because the argument I’ve made seems to make some sense, but it is hard to reconcile with your own notions of research and scientific advancement, I suggest you read further about the consequence of pulling the curtain aside on EBM.