And I add: What about "sciences without (material) evidence"? Why is it considered "unscientific" to accept a truth that does not impact on the senses, and therefore, cannot be "measured"?
Yes, it is "philosophy" and "metaphysics"!
Hope to hear from you!
Wendy
Evidence: A Seductive but Slippery Concept - The Scientist - Magazine of the Life Sciences
Volume 24 | Issue 12 | Page 32
Date: 2010-12-01
Evidence: A Seductive
but Slippery Concept
Medical guidelines based on so-called scientific evidence
are not a panacea.
Andrzej Krauze
Much of what we know is wrong—or at least not definitively established to be right. My early years in science and medicine taught me that, so it was with some excitement that I heard the phrase “evidence-based medicine” in the early 1990s. Finally, we would work out what we knew and what we didn’t know.
Soon we had evidence-based everything: medicine, practice, policy, nursing, editing. Marketing departments learned the magic of the phrase, and it appeared four times in the BMJ (which I used to edit) in 1993, 15 in 1994, 285 in 2000, 327 in 2004, and 287 in 2009. Those figures tell a story of explosive expansion, and perhaps of recent decline.
From the beginning there were different schools of evidence-based medicine, reminding me of the feuding schools of psychoanalysis. For some it meant systematic reviews of well-conducted trials. For others it meant systematically searching for all evidence and then combining the evidence that passed a predefined quality hurdle. Quantification was essential for some but unimportant for others, and the importance of “clinical experience” was disputed.
There was also a backlash. Many doctors resented bitterly the implication that medicine had not always been based on evidence, while others saw unworthy people like statisticians and epidemiologists replacing the magnificence of clinicians. Many doctors thought evidence-based medicine a plot driven by insurance companies, politicians, and administrators in order to cut costs.
We must never forget
the complex relationship
between evidence and the truth.
the complex relationship
between evidence and the truth.
The medical establishment, however, soon recognized the need to embrace the term “evidence-based,” and wouldn’t have dreamt of producing a guideline that didn’t feature the two words in its title; various politicians also vowed to make everything evidence-based. Temples devoted to this new form of medicine—like the Cochrane Collaboration and the UK’s National Institute for Health and Clinical Excellence (NICE)—flourished, and the BMJ, I must confess, rode the wave, attracting lots of attention and money.
The discomfort of many clinicians comes from the fact that the data are derived mainly from clinical trials, which exclude the elderly and people with multiple problems. Yet in the “real world” of medicine, particularly general practice, most patients are elderly and most have multiple problems. So can the “evidence” be applied to these patients? Unthinking application of multiple evidence-based guidelines may cause serious problems, says Mike Rawlins, chairman of NICE.
There has always been anxiety that the zealots would insist evidence was all that was needed to make a decision, and in its early days NICE seemed to take this line. Critics quickly pointed out, however, that patients had things called values, as did clinicians, and that clinicians and patients needed to blend their values with the evidence in a way that was often a compromise.
Social scientists have tended to be wary of the reductionist approach of evidence-based medicine and have wanted a much broader range of information to be admissible. Evidence-based medicine has been at its most confident when evaluating drug treatments, but many interventions in health care are far more complex than simply prescribing a drug. Insisting on randomized trials to evaluate these interventions may not only be inappropriate, but also misleading. Interventions may be stamped “ineffective” by the hardliners when they actually might offer substantial benefits. Then there is the constant confusion between “evidence of absence of effectiveness” with “absence of evidence of effectiveness”—two very different things.
Finally, even some of the strongest proponents of evidence-based medicine have become uneasy, as we have increasing evidence that drug companies have managed to manipulate data. In the heartland of evidence-based medicine—drug trials—the “evidence” may be unreliable and misleading.
All this doesn’t mean that evidence-based medicine should be abandoned. It means, rather, that we must never forget the complex relationship between evidence and truth.
Richard Smith is a member of the board of the Public Library of Science and a former editor of the BMJ and chief executive of the BMJ Publishing Group.
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