Rethinking Evidence-Based Medicine: from rubbish to real

Too much evidence is flawed, out of date, financially conflicted, suffering from publication bias. Amen.

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Trish Greenhalgh, an EBM critic, recently challenged Carl Heneghan on Twitter to promote real EBM, as opposed to the rubbish version. In response Carl proposed a meeting, for which I had the great pleasure (and stress!) of facilitating. There were quite a few EBM bigwigs, and as @mgtmccartney noted, the room was full of heroes such as Druin Birch, Jon Brassey, Martin Burton, Hasok Chang, Iona Heath, Richard Lehman, Mike Kelly, Neal Maskrey, Margaret McCartney, Rory Milne, and Des Spence. Details have been storified on Twitter so I won’t repeat them here.

To me (and not necessarily others in the group) the meeting revealed serious problems:

  1. Too much evidence is flawed (out of date, financially conflicted, and suffering from publication bias).
  2. This flawed evidence is used (often via guidelines) as a stick to beat clinicians. If your doctor doesn’t follow the guideline (even if…

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