May 21, 2017

What evidence based medicine is not

It is important not to just learn what things are, but also to learn what they are not. As this article states:

On the surface, EBM proposes a specific association between medical evidence, theory, and practice. EBM does not, however, offer a new scientific theory of medical knowledge,16,17 but instead has progressed as a coherent heuristic structure for optimising the practice of medicine, which explicitly and conscientiously attends to the nature of medical evidence. Central to the epistemology of EBM is that what is justifiable or reasonable to believe depends on the trustworthiness of the evidence, and the extent to which we believe that evidence is determined by credible processes.17 Although EBM acknowledges a role for all empirical observations, it contends that controlled clinical observations provide more trustworthy evidence than do uncontrolled observations, biological experiments, or individual clinician’s experiences.

The basis for the first EBM epistemological principle is that not all evidence is created equal, and that the practice of medicine should be based on the best available evidence. The second principle endorses the philosophical view that the pursuit of truth is best accomplished by evaluating the totality of the evidence, and not selecting evidence that favours a particular claim.

Evidence is, however, necessary but not sufficient for effective decision making, which has to address the consequences of importance to the decision maker within the given environment and context. Thus, the third epistemological principle of EBM is that clinical decision making requires consideration of patient's’ values and preferences.

The recognition that values and preferences vary widely among individuals has an important implication: the standardisation of care, which was one of the original reasons for the introduction of guidelines, and is still considered a key rationale for assessing the quality of care initiatives, is neither possible nor desirable for the many value and preference-sensitive decisions that clinicians and patients face.

EBM has yet to generate a coherent theory of health-care decision making and will continue to partner with other disciplines, such as cognitive and decision sciences, toward this goal.

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1. You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.
2. You should list any points of agreement (especially if they are not matters of general or widespread agreement).
3. You should mention anything you have learned from your target.
4. Only then are you permitted to say so much as a word of rebuttal or criticism.
Daniel Dennett, Intuition pumps and other tools for thinking.

Valid criticism is doing you a favor. - Carl Sagan