Don't let ‘eminence-based' trump evidence-based medicine

The difference between eminence and evidence is a mere three letters, but the impact on patients could be life or death. Larry Husten, Ph.D., a healthcare journalist, takes the medical establishment to task for allowing the “big dirty secret” of what he calls “eminence-based medicine” to trump the science.

Much of the buzz in healthcare today is about evidence-based medicine, and Husten charges in MedPage Today that too many eminent thought-leader physicians are using a “barrage of statistics” to essentially back up their theories on novel approaches to care.

“At each step of the argument, the logic will appear flawless, even brilliant,” he writes. “But, in general, the entire purpose of [a] talk will be to ‘prove’ the thought leader's opinion, despite the complete lack of genuine reliable evidence, or to disprove the actual evidence that exists, because it fails to support that opinion.”

Comparing the medical establishment to the military, Husten is equally critical about the lack of questioning by physicians of thought leaders who don’t have hard evidence to back up their theories. He also likens medical training to military training, where “immediate and unreflecting obedience is the goal.”

Husten questions why physicians are so unwilling to challenge their colleagues. He specifically cites an example of a cardiologist in Maryland who implanted stents in patients who didn’t need them--and all of the cardiologist’s colleagues were silent about the practice.

While he’s clear to draw a distinction between the pervasiveness of eminence-based medicine and the number of sexual assaults on patients witnessed by trainees during surgeries, Husten writes that it’s the culture of medicine that allows both to continue unabated and unquestioned.

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