Practicing Evidence-Based Medicine

Feb 24, 2017

By Steven Novella

An excellent article in ProPublica by David Epstein discusses the problem of doctors not adhering to the best evidence-based standards. The full article is worth a read, and I won’t just repeat it here, but I do want to highlight a few points which align well with what I have been writing here and at SBM for years.

The essential problem is that there is a disconnect between the best evidence-based standards and what is actually practiced out in the world. There are actually two problems here. The first is the scientific evidence itself. The second is the alignment of practice to this evidence.

Scientific evidence in medicine has a few challenges. There is publication bias, researcher bias, p-hacking, the decline effect, and problems with replication. What all of this adds up to is that there is a lot of published preliminary evidence, most of which is wrong in the false positive direction. There is a tendency, in my opinion, of adopting treatments prematurely.

Continue reading by clicking the name of the source below.

2 comments on “Practicing Evidence-Based Medicine

  • Unfortunately, you have go to the article, and skip past what the author wrote, down to the comments, to find the all important issue of how financial incentives are distorting care away from evidence based or science based medicine. It is quite shocking to learn of all the pay-offs going on. This ranges from consultant fees to medical researchers from big pharma, to advertising space in journals right next to research articles that were partially funded by the same drug company, to medical research schools being funded in part by these entities, to over-worked doctors being constantly given the hard sell by drug company reps. Then there is the revolving door between FDA/NIH and the drug companies. Three lobbyists to every congressperson. We’re talking about a 2.7 trillion dollar per year industry in the U.S., which is to be compared to a 1 trillion dollar fossil fuel industry. So my advice is to be a little skeptical. Double-blind studies are great, but it really requires a holistic evaluation of all possible treatment options with an eye to the incentives to suggest the ones with the biggest profits for all concerned. The more homework you can do the better. Ask questions, don’t be intimidated by the doctors, or accept their advice unquestioningly. That’s not scientific!



    Report abuse

  • Joel G. #1
    Feb 26, 2017 at 7:06 pm

    Unfortunately, you have go to the article, and skip past what the author wrote, down to the comments, to find the all important issue of how financial incentives are distorting care away from evidence based or science based medicine.
    It is quite shocking to learn of all the pay-offs going on.

    It is indeed shocking, so the best way to tackle this, is to have a funded public health service which investigates products and their pricing, and then negotiates prices and purchases on the basis of effectiveness, value, and production costs, on behalf of the consumer.
    This is one of the reasons why citizens in OECD countries which have public health services, pay around half as much for healthcare as Americans.

    On top of the issues you raise about abuses within mainstream medicine, there are questions of the more or less unregulated “alternative medicines” and quackery, where the uneducated are at a loss to know what is unevidenced advertising hype, and what is effective, safe, medical treatment.
    Many charlatans operate in these fringe areas – or even merge their quack activities with real medical treatments within their privately run establishments (labelled as “clinics”).



    Report abuse

Leave a Reply

View our comment policy.