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Sunday, February 18th 2007

Evidence Based Medicine In The Press

I’m really hoping that Medrants sees this article in Time and takes on its summary of evidence based medicine.

Evidence-based medicine, which uses volumes of studies and show-me skepticism to answer such questions, is now being taught–with varying degrees of success–at every medical school in North America. It has been extraordinarily successful in shooting down some of the most cherished beliefs in health care, like the idea that long-term hormone-replacement therapy would help prevent heart disease in women. And it has clearly saved lives. Many doctors used to give anti-arrhythmia drugs to everyone who experienced irregular heartbeats after a heart attack because severely irregular beats could rapidly prove fatal. But then came the results of a randomized trial showing that patients with only mildly irregular heartbeats were more likely to die if given the anti-arrhythmia medication than their untreated counterparts were. Doctors now prescribe more judiciously, though treatment still saves lives in the case of severe arrhythmias.

I don’t know enough to have a negative opinion of EBM, but I will take the article in Time to task for how it begins,

Nobody pretends medicine is easy, but if there’s one thing we ought to be able to rely on, it’s that the doctors looking out for us are doing more than playing hunches. We take certain medicines because they work, right? We go into the operating room for certain procedures because they’ll make us well, don’t we?

The author’s answer is: no. But this is a ridiculous statement, which plays to the expectations game again.

Medicine is not a pure science. And your disease is unique, there will never be a time – without having seen you – we’ll know enough to be able to predict, within the range of other sciences, whether your “mildly irregular heart beat” will turn into v-tach.

Comparing it to a pure science, like physics: the study isn’t to come up with an all encompassing formula for a disease process, it is to come up with six billion formulas for all individuals who might have the disease.

Downplaying what physicians do as “playing hunches,” because they know while this will work the vast majority of the time, it won’t work 100% of the time…is ridiculous.

You should expect more from your health care. However “failures” aren’t largely a fault of the process or of the science, so while there are corrections to be made, there are none that will allow us to say: “Well, this surgery is absolutely-positively guaranteed to make you better.” And that seems to be what the article is holding out EBM as a promise of.

[Wikipedia: Evidence-based Medicine]