I consider myself an advocate of evidence-based medicine. Generally, I have little patience for people who advocate for unproven medical approaches (or worse, "alternative medicines" that have been specifically proven in repeated studies to be useless). I am a regular reader of science-based medicine blogs such as the excellent (if often monotonous and occasionally strident) sciencebasedmedicine.org.
In my role as cancer survivor, I would say I have been subjected to a greater number of these kinds of advocacies than the average person, too.
Nevertheless, any kind of advocacy – even the advocacy for evidence-based medicine – can be taken too far. The excessive push for the "gold-standard" – randomized controlled trials - in every type of health-focused intervention can certainly be carried too far. I ran across this excellent, short satire that appears, "played straight," at the British Medical Journal website. Here is a sampling.
Abstract
Objectives: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
Design: Systematic review of randomised controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure: Death or major trauma, defined as an injury severity score > 15.
Results: We were unable to identify any randomised controlled trials of parachute intervention.
Conclusions: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
I like the bit about "trauma related to gravitational challenge."
Addendum: Actually, before someone complains, I think I should clarify that I acknowledge at least a limited understanding that there is an important technical difference between the concepts of "science-based medicine" and "evidence-based medicine," and that, in fact, this satire is essentially a criticism of the latter from the perspective of the former.
[daily log: walking, 7km]
