The illusion of evidence based medicine
Over the years I&#x27;ve practiced medicine the idea of &quot;evidence-based&quot; care has had its ups and downs.<p>Part of the problem lies in the question of what is &quot;evidence&quot;. From what I&#x27;ve seen, heard and read, the question is broader than pharmaceutical research though that&#x27;s certainly an important element. The evidence literature spans making diagnoses, applying drug and non-drug therapies, deciding what is a successful outcome of treatment, etc.<p>What I see is that clinicians are quite willing to use relevant and effective evidence-based methods. One problems applying evidence to real-world practice arises out of the aggregate bases of evidence. Even if evidence-based approaches could work in typical cases, many patients vary enough from norms that following evidence-based recommendations doesn&#x27;t work.<p>Furthermore it shouldn&#x27;t be surprising when low-quality evidence gains corporate or governmental backing. When such promoted &quot;standards&quot; defy clinical observation it tarnishes the idea of evidence-based practice. An example is fairly recent recommendations that men over 70 shouldn&#x27;t have routine PSA lab tests. Urologists will tell you about the hundreds of men they see with early stage prostate cancer detected by periodic PSA tests. Following the &quot;evidence&quot; would result in far more deaths and disability so it&#x27;s ignored.<p>As the article points out corruption of &quot;evidence-based medicine&quot; has destroyed much of the promise the idea once held. Insurers, pharma houses, governments contribute to abuse of evidence to serve their own agendas. No doubt some fraction of practitioners have added to problems and that needs to be halted. But IMO regulators are quick to point fingers at all clinicians for failures of health care systems. Rather most providers would prefer to avoid corrupt &quot;evidence&quot; whereas real evidence is welcome to workers toiling in the trenches.