Another fascinating critique of "evidence-based medicine" (EBM) first published in 1998 in Quarterly Medicine Journal, then re-posted in full by this blogger last year. Like the blogger, I find it startlingly topical.

Read in full here: https://bluewatsons.tumblr.com/post/643518173530996736/b-g-charlton-a-miles-the-rise-and-fall-of ("The Rise and Fall of EBM" by BG Charlton and A Miles)

A pithy quote, relevant to several of the themes regularly address in the ecosophia blogs:

"It is doubtful whether such a crude, question-begging tactic as naming oneself ‘evidence-based’ would have had much influence upon clinicians and medical scientists. However, the proponents of EBM cleverly bypassed doctors and appealed directly to politicians, health service managers, public health professionals and the newly expanded ranks of number-crunchers’ (epidemiologists, biostatisticians, information technologists, health economists, etc.). Such personnel had emerged in enormous numbers as a consequence of the centralizing and regulating tendency of the NHS reforms, and they were seeking tools of legitimation.

"EBM was seized upon by managers and their myrmidons, and promoted with a massive injection of publicity, money and organizational infrastructure. The consequence has been an astonishing trans- formation from the clinically-led approach of CE to the managerially-led approach of EBM. Instead of a bottom-up system using epidemiology to inform good practice, the NHS bureaucracy has introduced a top-down system which employs statistical data to define, prescribe, monitor and enforce specific practices upon clinicians.

"It seems likely that NHS management were so quick to advance EBM because they saw its potential as a ‘quality assurance’ tool capable of regulating, not just medical practice, but the whole of the health service. Traditional managerial and audit methods require a conveniently measurable output, and clinical services are notoriously difficult to quantify. However ‘quality assurance’ audit concentrates not on performance but on the system— quality is defined and measured in terms of the operations of a control and feedback system."

I would just add that when one takes issue with an EBM "pronouncement" or statistic, or with "expert advice" derived from same, one is habitually accused of treating evidence casually, and/or of a cavalier disrespect for the professionalism of doctors. This piece of (I'd call it) journalism delves into the reasons both such accusations are baseless.