Evidence-Based Medicine Backlash
Last week's Time Magazine article on Evidence-Based Medicine seems to me to damn it with faint praise:
Evidence-based medicine, which uses volumes of studies and show-me skepticism to answer such questions, is now being taught--with varying degrees of success--at every medical school in North America. ... Advocates believe that evidence-based medicine can go much further, reducing the reliance on expert opinion and overturning the flawed assumptions and even financial incentives that underlie many decisions. ... But is such certainty possible--or even desirable? Medicine, after all, is a personalized service, one built around the uniqueness of each patient and the skilled physician's ability to design care accordingly. ...
Consider the case of Dr. Daniel Merenstein, a family-medicine physician trained in evidence-based practice. In 1999 Merenstein examined a healthy 53-year-old man who showed no signs of prostate cancer. As he had been taught, Merenstein explained ... there is little evidence that early detection makes a difference in whether treatment could save your life. As a result, the patient did not get a PSA test. Unfortunately, several years later, the patient was found to have a very aggressive and incurable prostate cancer. He sued Merenstein for not ordering a PSA test, and a jury agreed--despite the lack of evidence that it would have made a difference. Most doctors in the plaintiff's state, the lawyers showed, would have ignored the debate and simply ordered the test. Although Merenstein was found not liable, the residency program that trained him in evidence-based practice was--to the tune of $1 million...
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