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"Rifts and Bright Spots in Evidence-Based Medicine" (report on day 2 of Evidence Live conference)

Dolphin

Senior Member
Messages
17,567
Rifts and Bright Spots in Evidence-Based Medicine
By Hilda Bastian
Posted: April 17, 2015
http://blogs.plos.org/absolutely-maybe/rifts-and-bright-spots-in-evidence-based-medicine/

I (and some other people) can get a bit tired of claims that CBT and GET are evidence-based therapies for ME/CFS which can lead us to question whether evidence-based medicine is not without its flaws.
Here's a report on a recent conference where some people who are big into evidence-based medicine are questioning it.

Unfortunately it didn't give as much detail as I would have liked to understand the flaws that were being raised (or maybe they did if I had followed the links?)

(Perhaps of interest to @alex3619 ?)
 

Jonathan Edwards

"Gibberish"
Messages
5,256
I (and some other people) can get a bit tired of claims that CBT and GET are evidence-based therapies for ME/CFS which can lead us to question whether evidence-based medicine is not without its flaws.
Here's a report on a recent conference where some people who are big into evidence-based medicine are questioning it.

Unfortunately it didn't give as much detail as I would have liked to understand the flaws that were being raised (or maybe they did if I had followed the links?)

(Perhaps of interest to @alex3619 ?)

As I understand it the main problem about EBM is the constipated mindset it encourages. Having a meeting to discuss a method for making it less constipated threatens perhaps to be even more constipated. A good dose of curry might help.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
EBM is a management tool. Its not science. It can use science, but in itself its not science. It can achieve really good things. It can also stuff up.

Like statistical significance, which can rubber stamp bias (bias can be systemic, and significant results can be found across a whole methodology), EBM can rubber stamp systematic bias. This includes meta-analyses. GIGO, or in the context I used it recently, BIBO, babble in, babble out.

I keep reading complaints about how the IOM report left out a lot of evidence, with an implication of bias. Its the methodology that is biased. EBM style reviews are good for rapidly evaluating mature bodies of scientific literature. It can be a disaster at the cutting edge of science.

I am too busy to read the article for a few hours, maybe even for today. I will give it a go later.

Montezumas revenge as a cure for EBM? It definitely needs a good purging.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
We need more breadth, more balance, and more doubt,

There is a rift in EBM, between the population and the individual, between significance and meaning

Clinicians, she said, need more support for thinking critically about evidence – and they shouldn’t let drug reps through the door, either!

Scientific evidence is critical, but the biases of the EBM movement’s own intellectual and commercial interests end up distorting both the evidence and clinical practice.

Social forces, complexity, and bias drive uncritical acceptance of highly biased systematic reviews – and those who criticize such reviews face considerable attack. We’ve lost sight of the fact that systematic reviews and meta-analyses are descriptive or observational studies, so they are very much at risk of bias themselves.

The movement’s growing commercial interests put it squarely at odds with the public interest.

Some quotable quotes. I am largely in agreement with this article.