The Fatal Failings of Evidence Based Medicine

The medical system (and much of the culture) these days is focused on group outcomes, not individuals. Personally, I think that stinks.
In medicine, this failing comes from improper use of what was originally a good idea—evidenced based medicine (EBM). EBM was developed to help overcome anecdotal medicine, in which a seemingly successful therapy in one patient gets adopted by a physician as the “way to go” and then preached to his trainees as the management of choice, and over time becomes unexamined gospel. “Anecdote-based medicine” is a form of groupthink, and groupthink is bad in general and particularly bad for the patient sitting in front of us on an exam table.
There needed to be some way to help doctors realize that an individual patient response is not generalizable to others.
EBM evaluates groups of patients to determine statistical responses to interventions. It was created (initially) to help doctors determine whether an intervention is likely to work in an individual patient. In that way, it was originally kind of the obverse of anecdotal medicine.

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Academic Medicine? No way! (But are you so sure?)

The doctor business is win-win: doctor wins, patient wins. In sharp contrast, the legal profession is a win-lose dichotomy. That is one reason why we choose medicine. It is a huge difference in psychology that gets into our very bones. Becoming a doctor is a highly noble pursuit. Being a doctor is fun, exciting, worthwhile, productive and assuredly positive. Doctors create wealth in the world by increasing the ability of people to pursue their happiness. What in the physical realm could be more worthwhile than that?
But medicine can be an all-consuming life choice. Before embarking on it, ask yourself if you can tolerate sacrificing a large percentage of everything else you enjoy to do, and everyone you like to be with, for a long time. The job is great. No doubt about it. But don’t naively minimize the sacrifices. Is it worth the sacrifice? Don’t let anyone other than you decide that.

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