The goal of an evidence-based approach is to rest treatment decisions on hard facts that are gathered carefully through a rigorous process of investigation – so that medical decisions can rest on a solid foundation of confirmed information – i.e., the truth.
Although medical care has always been informed by science, the previous standard for evidence was not so rigorous as it is today, and published research did not always adhere to the highest standards. Moreover, most physicians drew their knowledge from textbooks, which were written by experts, of course, but relied excessively upon personal knowledge and opinion, even speculation.
More to the point, differences of opinion at the bedside were settled by the academic hierarchy. Senior physicians ruled over juniors who outranked the residents. Usually, the most experienced professor had the final word.
Sometimes, however, the difference of opinion was settled by personality. Whoever spoke the most definitively and confidently (or the most loudly and obnoxiously) carried the day. Worst of all was the “Trumpian” alpha male who blustered made-up facts with absolute conviction and lured unsuspecting colleagues into his pretend world of truth.
Evidence-Based Medicine replaced this “might-makes-right” approach with a new paradigm, a world in which facts rule over opinions, and evidence drives out speculation. Above all, it is a world where objective reasoning dominates dogma. In this world there is no room for “fake news.”
From The Ailing Nation, Chapter Six: Evidence
My medical world is steeped in information, zillions of facts, that we physicians must parse to get to the correct answer because our treatment decisions must be based on the solid bedrock of truth. But where do we find this truth? How do we even know if it is real? The Evidence-Based Medicine movement, which started in the late 1980s and is now firmly entrenched in medical practice, is focused like a laser on these questions, and the medical community has, in turn, adopted techniques for discovering, interpreting, and sharing the truth. For example, we have settled on double-blind randomized controlled trials (RCTs) as the gold standard for unbiased evidence, and we have developed mechanisms for incorporating their results into practice guidelines so that every physician can be well informed about the latest in medical science. In fact, I have spent my career teaching young physicians the skills of medical practice in this paradigm. Over the past three decades, we have come a long way from the alpha male-directed practice of medicine. Wouldn’t it be great if the philosophy of EBM could creep into our political world? That is the goal of this website, to nudge our national leaders in this direction.