One of my favorite physician writers, Sherwin Nuland (How We Die) shares my malaise about the increasing penetration of ‘evidence-based medicine’ into medical practice. EBM is the slavish practice of basing medical decision-making only on the odds established by peer-reviewed research studies. It is all the buzz, and is especially amenable to the managed-care bureaucrats interested in denying reimbursement for healthcare itnerventions that aren’t ‘cost-effective’ or ‘proven.’ Evidence-based medicine, and the ‘treatment algorithms’ that accompany it, largely cripple what used to be one of the central intellectual tasks of the physician — being an intelligent consumer of the medical literature and a creative, indeed artistic, synthetist of research findings with one’s own clinical experience and the more anecdotal wisdom of one’s colleagues.
There are so many flaws with this way of doing business that I cannot begin to enumerate them in any better way than Nuland has done here. Just as consistency is the hobgoblin of small minds, the belief in ‘objectivity’ is sometimes little more than the last resort of the uncreative, the subjectively challenged. The practice of medicine has been considered an art as well as a science; imagine if artists in other fields were constrained to produce only the types of art the market researchers had ‘proven’ would sell to the masses, or the cognitive psychologists and neuroscientists had ‘proven’ would activate the proper aesthetic centers in the brain as measured by PET scan or fMRI?
The so-called objectivity of medical research is a misnomer in many ways, among them the prejudiced opinions about what is worthy of publication of the academic journal editors and referees; the bias in favor of positive findings at the expense of negative, refutory research results; and the increasing fist-in-glove control of the research industry by the pharmaceutical industry. (Slate)