Restoring the balance: evidence‐based medicine put in its place

Anaesthesia and evidence‐based medicine

“…[68] Naylor, Grahame-Smith, Eysenck, Wells, Thompson and Pocock and Bailar all caution against the simplistic insertion into evidence-based medicine of numbers derived from meta-analyses. Charlton [3,37,68,69] goes further. He denies that meta-analyses and megatrials are a sound base at all: that 'it is not a merely a question of EBM results being of limited relevance -they may be of no relevance.'…”

“…Given their selfprofessed abilities for the methodical processing of data, this implies either a disappointing lack of imagination, or a frightening degree of arrogance: both are dangerous qualities in the possessors of information. Charlton [3] is explicit: exponents of evidence-based medicine have accused doctors of 'unreasoning inertia, innate conservatism, enslavement to commercial propaganda, blind prejudice and entrenched authoritarian attitudes'. He (a nonpractising doctor himself) believes that 'doctor envy and antimedical prejudice are endemic throughout this paramedical domain'.…”

“…Charlton's most complete criticism of evidence-based medicine is his editorial commentary to a collection of papers forming a debate on evidence-based medicine [3]. He starts by distinguishing epidemiology, the basis of evidence-based medicine, from science.…”

“…Charlton [3] cites an article by Hampton, who has 'the contextual knowledge F F F [to focus] F F F on the wellcontrolled'. Following the recipes of evidence-based medicine does not 'bring with it an ability to make sense of the literature'.…”

“…Data are necessary to knowledge and understanding, but the spurious impression of data themselves being knowledge and understanding causes 'The problem [of] articulating to nonmedics what to do instead of EBM.' [3] Silverman suggested keeping in mind the advice of workers in fireworks factories: 'It is better to curse the darkness than to light the wrong candle.' Sensible though this advice is, it is an analogy that will simply be dismissed by those who do not accept the criticisms of Charlton and others.…”