Curse of the undead – the Evidence-Based Medicine zombie

In a nice overview of the Evidence-Based Medicine zombie, Bruce Charlton wrote, in 2009:

When the UK government finally understood that what was being proposed was a perfect rationale for re-moulding medicine into exactly the shape they had always wanted it – the NHS hierarchy were falling over each other in their haste to establish this new orthodoxy in management, medical education and in founding new government institutions such as NICE (originally meaning the National Institute for Clinical Excellence ā€“ since renamed [20]).

As soon as the EBM advocates knocked politely to offer a try-out of their newly-created Zombie; the door was flung open and the EBM-ers were dragged inside, showered with gold and (with the help of the like-minded Cochrane Collaboration and BMJ publications) the Zombie was cloned and its replicas installed in positions of power and influence.

Suddenly the Zombie science of EBM was everywhere in the UK because money-to-do-EBM was everywhere ā€“ and modern medical researchers are rapidly-evolving organisms which can mutate to colonize any richly-resourced niche ā€“ unhampered by inconveniences such as truthfulness or integrity [23]. Anyway, when existing personnel were unwilling, there was plenty of money to appoint new ones to new jobs.

Since then, it’s taken over as part of the global restructuring so many of us like to castigate these days, similar crimes against the person being perpetrated in education and the law. Two commenters on an article Doctors Urge Their Colleagues To Quit Doing Worthless Tests wrote:

I have worked as a nurse for many years. I have seen physicians wander into the floor, sign a chart to indicate they have met with a patient and leave. This physician did not see the patient or even read the chart, yet they received a consutant fee. This practice must also stop. [Kimberlain O’Driscoll]

And:

I would also like to see physicians return to actually looking at the patient, listening to the patient’s body, and then using tests only if necessary. My MIL was in the hospital with several major issues. Out of about 8 specialists, only one (the infectious disease specialist) would come in and actually look at her body, talk directly to her, and move her body or touch it to see what was going wrong. [Linda Rizzuto]

The article itself stated, for example:

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

A child with low belly pain and suspected appendicitis? Don’t rush her to the CT scanner. Do an ultrasound first. That will give the answer 94 percent of the time, is cheaper and doesn’t expose the child to radiation.

Interestingly, that was preceded, in the Wail:

For every life that is saved by breast cancer screening up to TEN women suffer ‘unnecessary treatment’ including breast removals.

No doubt you can quote hundreds more. There are so many questions the public can legitimately ask about this, as Chuckles does:

Why Evidence Based Medicine is managerialist rubbish, the insoluble problem of false positives, why medical tests are about making drug company shareholders and managers rich, and not about your health, why the NHS is a fiasco etc etc.

Bruce Charlton says it was a forlorn hope to tackle this monster, so beloved of lazy diagnostics, big money and government, the unholy triumvirate. Yet everyone knows it needs to be skewered – perhaps it will require a new St George for that to happen.

4 comments for “Curse of the undead – the Evidence-Based Medicine zombie

  1. David A. Evans
    April 11, 2012 at 4:57 pm

    I can’t remember the article now but I remember reading about how EBM was screwing up clinical trials too.

    DaveE.

  2. April 11, 2012 at 8:58 pm

    Bruce Charlton has a fair amount on that.

  3. April 11, 2012 at 10:11 pm

    There are also increasing concerns that a great deal of medical research isn’t even reproducible.

    http://blog.singularvalues.com/2012/04/medical-studies-not-reproduced.html

  4. john malpas
    April 12, 2012 at 12:40 am

    I often wonder why they train doctors for so long when they dont look or listen anymore.
    My GP is besotted with blood tests yet never pays any attention to my asthma or anything else. Odd really.
    Still I am still alive so it may be for my own good.

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