Evidence-Based Medicine Questioned

Evidence-based medicine, the Holy Grail of modern health care, again is being questioned.

"In medicine, evidence can be confusing" by USA Today reports that:

"Medicine is littered with missteps:

• For years, doctors urged post-menopausal women to take estrogen to protect their hearts. But in 2002, a study of 16,000 women found that those on estrogen plus progestin actually had more heart attacks than those on a placebo. In 2004, a similar study found no heart benefit from estrogen alone.

• In the 1980s, doctors enthusiastically prescribed two new drugs that seemed to eliminate one type of potentially dangerous irregular heart beat. But a 1989 study found that, compared to a placebo, the drugs actually raised the risk of sudden death.

• A 1968 report about one comatose patient concluded that dexamethasone, a corticosteroid, could save the lives of patients with deadly cerebral malaria. But a 1982 study of 100 comatose patients with cerebral malaria found that, compared to a placebo, dexamethasone actually prolonged comas.

Critics condemn evidence-based medicine as "cookbook medicine" that devalues the doctor's experience and the patient's preference. Proponents argue that evidence from randomized controlled trials has stanched the flow of private and public dollars for useless or even harmful treatments. More important, they say, the information has saved countless lives.

Both sides agree on one point: Keeping up with the latest evidence is virtually impossible."

True enough -- EBM's value is undeniable (better than making health care decisions without evidence), yet an orthodoxy by any other name can still be oppressive. The article is correct to point out "missteaps" of EBM.

The same article carries a subheading, "Wisdom has its place," and quotes former National Institutes of Health director Bernadine Healy for the proposition that "'here are multiple dimensions of evidence. There has to be a certain amount of wisdom, and a certain amount of clinical understanding.'"