Thursday, May 5, 2005
Slate's online magazine contains a new article entitled, "Bedside Wisdom: It still beats medicine-by-the-numbers. In the article, Sherwin B. Nuland discusses evidence-based medicine in response to a newly published book on that subject. He clearly is not a fan of such medicine. He does a nice job briefly tracing the development of clinical epidemiology and then he states,
Needless to say, the entire notion that there can be such a thing as an epidemiological or mass approach to individual patient care has been difficult for some observers to accept. And as to evidence-based medicine! In Evidence-Based Medicine and the Search for a Science of Clinical Care, Jeanne Daly, a medical sociologist who is co-editor of the Australian and New Zealand Journal of Public Health, presents with admirable balance both the good reasons to be wary of such a coolly distanced and data-drenched approach to patient care and the good reasons to be welcoming of it. But though I admire her fairness, I remain skeptical of the concept's ultimate implications. To be sure, evidence-based medicine offers a method to put diagnosis and therapy on as scientific a basis as possible, removing physician fallibility as well as guesswork. But it fails to account for the extent to which doctors' choices are affected by the multiple complicating factors inherent in any illness, or, for that matter, simultaneous illnesses, patients' biological differences, or the differing ways in which disease can interact with proposed therapies.
It is an interesting read.[bm]