Evidence based medicine (EBM) intrigues and challenges me. While I embrace its principles I am concerned when some proponents take ideas to extremes.
Norman Latov, M.D, Ph.D, professor of neurology at Cornell thinks the zealots of EBM have gone too far. His recent article in the Journal of American Physicians and Surgeons takes them to task. Many proponents of EBM eschew expertise, case reports and physiologic rationale which, Latov points out, were important in the pioneering work of Harvey, Pasteur and Osler.
I don’t agree with all of Latov’s statements (e.g., his implications that guidelines do more harm than good, that EBM makes no allowance for physician judgment, or that guideline adherence has not been shown to impact outcomes) but he makes many valid points.
Latov effectively challenges the orthodoxy of EBM, much of which is dogma rather than science. Counter-arguments such as his should help us refine and balance our views of EBM.