Open Access Open Access  Restricted Access Subscription Access

Tarnished Gold by Steve Hickey and Hilary Roberts: EBM as An Avatar of Modern Medicine

Peter Wyer, Suzana Alves Silva

Abstract


Despite many passing references to contemporary frontiers of thought such as cybernetics and complexity theory, Tarnished Gold, a self-published book, leads the reader towards critical visions of clinical research enterprise that are more linked to the past than to the present or the future. Along the way, Evidence Based Medicine is taken as the enemy, but is consistently misrepresented. The authors are seriously under-informed regarding contemporary issues and controversies related to the design of clinical research as well as the cognitive aspects of clinical practice.  They ignore the relevance of narrative and relationship-centered medicine to those issues and controversies. The actual challenges of healthcare in our time and its relationship to clinical research are largely avoided. As a result, “Tarnished Gold” fails to illuminate or inform lessons already learned from the controversies that have occurred since the appearance of EBM. More importantly, the authors fail to observe that the terms of the debate between EBM and its critics have changed in the direction of an integrative approach, based on considerations of not only the logic of scientific inference, but of contemporary understanding of clinical reasoning and of the forms of knowledge that underlie it. Some of those terms are addressed by this review.

Full Text:

PDF

References


Claridge, J.A. & Fabian, T.C. (2005). History and development of evidence-based medicine. World Journal of Surgery 29, 547-553.

Hickey, S. & Roberts, H. (2011). Tarnished Gold: The Sickness of Evidence-based Medicine.

Global Polio Eradication Initiative. http://www.polioeradication.org/. Accessed March 17, 2012.

British Society for Ecological Medicine. http://www.ecomed.org.uk/. Accessed March 17, 2012.

Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. & Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal 312, 71-72.

Sackett, D.L., Haynes, R.B. & Tugwell, P. (1985). Clinical Epidemiology. Boston: Little, Brown and Company.

Eddy, D.M. (2005). Evidence-based medicine: A unified approach. Health Affairs 24, 9-17.

Wennberg, J. & Gittelsohn, A. (1973). Small Area Variations in Health Care Delivery. Science 182, 1102-1111.

Wyer, P.C. & Silva, S.A. (2009). Where Is The Wisdom: I. A Conceptual History of Evidence Based Medicine Journal of Evaluation in Clinical Practice 15, 891-898.

Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. Journal of the American Medical Association 268, 2420-2425.

Nasca, T.J., Philibert, I., Brigham, T. & Flynn, T.C. (2012). The Next GME Accreditation System - Rationale and Benefits. New England Journal of Medicine 366, 1051-1056.

Charlton, B.G. & Miles, A. (1998).The rise and fall of EBM. Quarterly Journal of Medicine 91, 371-374.

Eddy, D.M. (1990). Practice policies: Where do they come from? Journal of the American Medical Association 263, 1266-1275.

Feinstein, A.R. (1968). Clinical epidemiology I. The populational experiments of nature and of main in human illness. Annals of Internal Medicine 69, 807-820.

Bastian, H., Glasziou, P. & Chalmers, I. (2010). Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7, e1000326.

Kuhn, T.S. (1962). The Structure of Scientific Revolutions. Chicago: University of Chicago Press.

Tanenbaum, S.J. (1993). What Physicians Know. New England Journal of Medicine 329, 1268-1271.

Charon, R. (2001). Narrative Medicine: A model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286, 1897-1902.

Haynes, R.B., Devereaux, P.J. & Guyatt, G.H. (2002). Physicians' and patients' choices in evidence based practice: Evidence does not make decisions, people do. British Medical Journal 324 (7350) 1350.

Haynes, R.B., Devereaux, P.J. & Guyatt, G.H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. American College of Physicians Journal Club 136, A11-A14.

Haynes, R.B., Sackett, D.L., Gray, J.R., Cook, D.C. & Guyatt, G.H. (1996). Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions [Editorial]. American College of Physicians Journal Club 125, A14-A16.

Charles, C., Gafni, A. & Freeman, E. (2010). The evidence-based medicine model of clinical practice: scientific teaching or belief-based preaching? Journal of Evaluation in Clinical Practice 17, 597-605.

Silva, S.A. & Wyer, P.C. (2009). Where is the wisdom? II – Evidence-based medicine and the epistemological crisis in clinical medicine. Exposition and commentary on Djulbegovic, B., Guyatt, G. H. & Ashcroft, R. E. (2009) Cancer Control 16, 158–168. Journal of Evaluation in Clinical Practice 15, 899-906.

Tonelli, M.R. & Callahan, T.C. (2001). Why Alternative Medicine Cannot Be Evidence-based. Academic Medicine 76, 1213-1220.

Tonelli, M.R. (1998). The philosophical limits of evidence-based medicine. Academic Medicine 73, 1234-1240.

Malterud, K. (1995). The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine. Theoretical Medicine and Bioethics 16 (2) 183-198.

Djulbegovic, B., Guyatt, G.H. & Ashcroft, R.E. (2009). Epistemologic Inquiries in Evidence-Based Medicine. Cancer Control 16, 158-168.

Miles, A. (2009). Evidence-based medicine: requiescat in pace? A commentary on Djulbegovic, B., Guyatt, G. H. & Ashcroft, R. E. (2009) Cancer Control 16, 158–168. Journal of Evaluation in Clinical Practice 15, 924-929.

Brown, P. (1995). Naming and Framing: The Social Construction of Diagnosis and Illness. Journal of Health and Social Behavior 35 (Supplement) 34-52.

Sehon, S.R. & Stanley, D.E. (2003). A philosophical analysis of the evidence-based medicine debate. BMC Health Services Research 3, 14.

Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualized care. Journal of Evaluation in Clinical Practice 17, 531-536.

Miles, A. & Mezzich, J.E. (2012). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Freire, P. (1974). Education for Critical Consciousness. New York: Continuum.

Greenhalgh, T. & Russell, J. (2006). Promoting the Skills of Knowledge Translation in an Online Master of Science Course in Primary Health Care. Journal of Continuing Education in the Health Professions 26, 100-108.

Varela, F.J., Thompson, E. & Rosch, E. (1991). The Embodied Mind. Cambridge, MA: MIT.

Krimsky, S. (2004). Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? Lanham, MD: Rowman and Littlefield.

Horton, R. (2004). The Dawn of McScience. New York Review of Books 51, 7-9.

Smith, R. (2005). Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. PLoS Medicine 2, e138.

Montori, V.M., Jaeschke, R., Schunemann, H.J., Bhandari, M., Brozek, J.L., Devereaux, P.J. & Guyatt, G.H. (2004). Users' guide to detecting misleading claims in clinical research reports. British Medical Journal 329 (7474) 1093-1096.

Montori, V.M., Permanyer-Miralda, G., Ferreira-Gonzalez, I., Busse, J.W., Pacheco-Huergo, V., Bryant, D., Alonso, J., Akl, E.A., Domingo-Salvany, A., Mills, E. & Wu, P. (2005). Validity of composite end points in clinical trials. British Medical Journal 330 (7491) 594-596.

Wyer, P.C., Perera, P., Jin, Z., Zhou, Q., Cook, D.J., Walter, S.D. & Guyatt, G.H. (2006). Vasopressin or Epinephrine for Out-of-Hospital Cardiac Arrest. Annals of Emergency Medicine 48, 86-97.

Montori, V.M., Devereaux, P.J., Adhikari, N.K., Burns, K.E., Eggert, C.H., Briel, M., Laccetti, C., Leung, T.W., Darling, E., Bryant, D.M., Bucher, H.C., Schünemann, H.J., Meade, M.O., Cook, D.J., Erwin, P.J., Sood, A., Sood, R., Lo, B., Thompson, C.A., Zhou, Q., Mills, E. & Guyatt, G.H. (2005). Randomized trials stopped early for benefit: a systematic review. Journal of the American Medical Association 294 (17) 2203-2209.

Barratt, A., Wyer, P.C., Hatala, R., McGinn, T., Dans, A.L., Keitz, S., Moyer, V., For, G.G. & Evidence-Based Medicine Teaching Tips Working Group. (2004).Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. Canadian Medical Association Journal 171 (4) 353-358.

U.S. Preventive Services Task Force. (2009). Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 151, 716-726.

Nelson, H.D., Tyne, K., Naik, A., Bougatsos, C., Chan, B.K. & Humphrey, L. (2009). Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. Annals of Internal Medicine 151, 727-737.

Quanstrum, K.H. & Hayward, R.A. (2010). Lessons from the mammography wars. New England Journal of Medicine 363, 1076-1079.

Institute of Medicine. (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, D.C.: National Academies Press.

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. & PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6 (7) e1000097.

Eyding, D., Lelgemann, M., Grouven, U., Härter, M., Kromp, M., Kaiser, T., Kerekes, M.F., Gerken, M. & Wieseler, B. (2010). Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. British Medical Journal 341, c4737.

Loder, E. & Godlee, F. (2010). Missing clinical trial data: setting the record straight: Urgent action is needed to restore the integrity of the medical evidence base. British Medical Journal 341, 787-788.

Turner, E.H., Knoepflmacher, D. & Shapley, L. (2012). Publication Bias in Antipsychotic Trials: An Analysis of Efficacy Comparing the Published Literature to the US Food and Drug Administration Database. PLoS Med. 9 (3) e1001189.

Montori, V., Ioannidis, J. & Guyatt, G. (2008). Advanced Topics in Systematic Reviews: Reporting Bias. In: Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd edn. (Guyatt, G., Rennie, D., Meade, M.O. & Cook, D.J., eds.) pp. 543-554. NY: McGraw-Hill.

Feinstein, A.R. (1983). An Additional Basic Science for Clinical Medicine: II. The Limitations of Randomized Trials. Annals of Internal Medicine 83, 554-550.

Feinstein, A.R. & Horwitz, R.I. (1997). Problems in the “Evidence” of “Evidence-based Medicine” American Journal of Medicine 103, 529-535.

Westfall, J.M., Mold, J. & Fagnan, L. (2007). Practice-based research: “Blue Highways” on the NIH roadmap. Journal of the American Medical Association 297, 403-406.

Sox, H.C. (2009). Comparative effectiveness research: A report from the Institute of Medicine. Annals of Internal Medicine 151, 203-205.

Sox, H.C. (2010). Defining Comparative Effectiveness Research: The Importance of Getting It Right. Medical Care 48 (Supplement 1) S7-S8.

Oxman, A.D., Lombard, C., Treweek, S., Gagnier, J.J., Maclure, M. & Zwarenstein, M. (2009). Why we will remain pragmatists: four problems with the impractical mechanistic framework and a better solution. Journal of Clinical Epidemiology 62 (5) 485–488.

Ware, J.H. & Hamel, M.B. (2011). Pragmatic Trials — Guides to Better Patient Care? New England Journal of Medicine 364, 1685-1687.

Black, N. (1996). Why we need observational studies to evaluate the effectiveness of health care. British Medical Journal 312, 1215-1218.

Brewin, C.R. & Bradley, C. (1989). Patient preferences and randomized clinical trials. British Medical Journal 299, 313-315.

King, M., Nazareth, I., Lampe, F., Bower, P., Chandler, M., Morou, M., Sibbald, B. & Lai, R. (2005). Impact of participant and physician intervention preferences on randomized trials: a systematic review. Journal of the American Medical Association 293 (9) 1089–1099.

Clancy, C. & Collins, F.S. (2010). Patient-Centered Outcomes Research Institute: The Intersection of Science and Health Care. Science Translational Medicine 2 (37) 37cm18.

Guyatt, G.H., Oxman, A.D., Kunz, R., Vist, G.E., Falck-Ytter, Y. & Schünemann, H.J. (2008). What is "quality of evidence" and why is it important to clinicians? British Medical Journal 336, 995-998.

Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., Schünemann, H.J. & GRADE Working Group. (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. British Medical Journal 336, 924-926.

Eddy, D.M., Adler, J., Patterson, B., Lucas, D., Smith, K.A. & Morris, M. (2011). Individualized guidelines: the potential for increasing quality and reducing costs. Annals of Internal Medicine 154, 627-634.

Frankovich, J., Longhurst, C.A. & Sutherland, S.M. (2011). Evidence-Based Medicine in the EMR Era. New England Journal of Medicine 365, 1758-1759.

Karanicolas, P.J., Montori, V.M., Devereaux, P.J., Schünemann, H., Guyatt, G.H. (2009). A new ‘‘Mechanistic-Practical’’ Framework for designing and interpreting randomized trials. Journal of Clinical Epidemiology 62, 479-484.

Peirce, C.S. (1878). Illustrations of the Logic of Science: Sixth Paper-Deduction, Induction and Hypothesis. Popular Science Monthly 13, 470-482.

Maclure, M. (1985). Popperian Refutation in Epidemiology. American Journal of Epidemiology 121, 343-350.

Norman, G. (2005). Research in clinical reasoning: past history and current trends. Medical Education 39, 418-427.

Schmidt, H.G., Norman, G.R. & Boshuizen, H.P.A. (1990). A Cognitive Perspective on Medical Expertise: Theory and Implications. Academic Medicine 65, 611-621.

Silva, S.A., Charon, R. & Wyer, P.C. (2011). The marriage of evidence and narrative: scientific nurturance within clinical practice. Journal of Evaluation in Clinical Practice 17, 585-593.

Epstein, R.M. & Peters, E. (2009). Beyond Information: Exploring Patient's Preferences. Journal of the American Medical Association 302, 195-197.

Barry, M.J. & Edgman-Levitan, S. (2012). Shared Decision Making: The Pinnacle of Patient-Centered Care. New England Journal of Medicine 366, 780-781.

Thaler, R.H. & Sunstein, C.R. (2003). Libertarian Paternalism. American Economic Review 93, 175-179.

Beach, M.C. & Inui, T. (2006). Relationship-centered Care: A Constructive Reframing. Journal of General Internal Medicine 21, S3-S8.




DOI: http://dx.doi.org/10.5750/ejpch.v1i1.643

Refbacks

  • There are currently no refbacks.