The Paradox of Evidence-based Medicine

By MICHEL ACCAD, MD Anish Koka recently wrote a great piece entitled “In Defense of Small Data” that was published on The Health Care Blog. While many doctors remain enamored with the promise of Big Data or hold their breath in anticipation of the next mega clinical trial, Koka skillfully puts the vagaries of medical progress in their right perspective. More often than not, Koka notes, big changes come from astute observations by little guys with small data sets. In times past, an alert clinician would make advances using her powers of observation, her five senses (as well as the common one) and, most importantly, her clinical judgment. He would produce a case series of his experiences, and others could try to replicate the findings and judge for themselves. Today, this is no longer the case. We live in the era of “evidence-based medicine,” or EBM, which began about fifty years ago. Reflecting on the scientific standards that the medical field has progressively imposed on itself over the last few decades, I can make out that demands for better scientific methodology have ratcheted up four levels: Beginning in the late 1960’s, and then throughout the 1970’s, some began to call attention to the need for better statistical science in research publications. Chief among those emphasizing this problem was Alvan Feinstein. Another important figure was Stanton Glantz, and there were others as well.  See, for example, this editorial in Circulation in 1980...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Featured Physicians THCB MICHEL ACCAD Source Type: blogs