'When we began, we were almost pariahs‘
From Friday's Globe and Mail
Published Friday, Oct. 30, 2009 12:00AM EDT
Evidence-based medicine is not universally embraced. Do you
still get a lot of push back?
Oh sure, that’s been going on since we started. When we began, we
were almost pariahs because, of course, all the old guys rejected it
because it challenged them and all the young guys loved it because
it gave them a way to challenge their seniors in a more polite way,
instead of simply telling them they were out of date. In addition,
people who are wed to certain policies, if they have already decided
what the answer is for an individual or a community, the last thing
they want to hear or see is evidence. So, they get quite upset
Is there also a misinterpretation of what evidence-based medicine
is? Some say it’s about double-blind clinical trials for everything and
that’s not possible.
To a certain extent, it’s a misinterpretation and to a certain extent it’s
about not understanding what EBM [evidence-based medicine] is really
about. EBM is not just about randomized trials. EBM is saying: Here is a
problem we have to solve and what is the best evidence we have right
now? If it’s a randomized trial or, even better, a systematic review, great. If
not, what is the next best evidence? In many cases we can’t wait to do
the trial. ...
...This is a problem I have to solve today, so what is the best evidence
available to me? I’ll take what I can get but at least I’m going to look for
evidence, not just depend on the experts.