Dr. Bernadine Healy, a columnist for U.S. News & World Report, used to be director of the National Institutes of Health, the world’s foremost collector of biomedical evidence. The fact that she is considered the only NIH director who demonstrated a political agenda is borne out by her astounding attack this week on the concept of “evidence-based medicine.” She goes so far around the bend as to align herself with the cranks who wrote that the use of actual evidence in medical decision-making constitutes “micro-fascism.”
Although the term is fairly new “evidence-based medicine” is simple. Take all the randomized clinical trials on a subject, run them through rigorous statistical analysis, take into account other kinds of studies, and reach a conclusion as to what works and what doesn’t.
We employ evidence to make almost every other decision in our lives, from choosing a cell phone plan, to buying a car to investing in the stock market. Evidence-based medicine is neither a cure-all nor plot against doctors. It is simply a tool for applying macro-facts to a set of individual micro-circumstances for which the correct answer has to be, “Is this right for me?”
US News is going to publish at least one response in its October 16 issue:
To the Editor:
Healy castigates the practice of evidence based medicine in her polemic as if it were anathema to medical science, and, more particularly, to the individual physician’s practice of medicine. Hippocrates knew that “Experience is delusory.” “Experience,” or anecdote, is sometimes helpful in medicine, but often harmful, because we physicians often internalize our experience into hard rules about treating patients. This often leads us down dangerous paths.
Evidence based medicine is long overdue counterweight to this kind of medical practice. EBM, when evidence is available, makes us think hard about our practices: Are we doing this because that’s the way we’ve always done it, or because we have scientific research to back up our decisions? Sadly, it is too often the former, because the evidence is just not there or has not yet been synthesized into a useful form, or, most commonly, not yet reached the physicians “in the trenches.” EBM is not “discarding or devaluing physician judgment,” as Healy argues, it is rather an attempt to make our judgment more rational.
I find it astonishing that Healy trumpets the jury awarding damages against a physician who did not order a PSA test based upon the best evidence available to him. Every physician should howl in protest at this outcome. Using this standard, we should all have monthly full body high speed CT scans and massive blood testing to search for every possible disorder that comes to the mind of the physician or the patient. But we do not practice this way because it is, yes, I’ll say it, stupid!
Evidence based medicine is not a “straightjacket”, but a means to an end: providing the best care based on the best scientific evidence we have.
Christopher M. Hughes, MD