"Evidence-based" is a really problematic term when it is used to protect bureaucracies and medical managerialism, rather than actually interact with scientific processes in an ethical way. Their anecdote is actually a good example of why evidence-based logic is not the end-all.
So if one person injects themselves with honey and wakes up tomorrow cured from Covid, we should inject everyone with honey? That’s the exact opposite of a scientific process.
Evidence-based medicine is the scientific process. Love seeing the grandstanding on this thread against EBM without a single practical alternate proposal. Instead of complaining, what do you propose instead?
Since no one wants to explain and you I just got downvoted, Barry James Marshall is ironically an example of EBM and is HIMSELF an active proponent of EBM.
He had a biological hypothesis that the scientific community disagreed with and tested it on himself for a case study to get data. That case study was successful and then became a clinical trial. That trial was replicated and shown to work. He then won a Nobel prize for that work and the risk he took. This is an evidence-based process. EBM doesn’t mean you disregard a N=1, it means you expand N=1 into N=10, then N=100,… before you apply something to the general population. This is loosely how phase-1,2,3,4 trials work in the US.
Dismissing EBM because of Marshall is like dismissing all of math because someone disproved a popular conjecture like the local-to-global conjecture. Sure the community sentiment had it wrong, but the systematic logical approach of Math got it right. In Marshall’s case the community sentiment had it wrong, but the EBM approach eventually got it right. Half this thread doesn’t even know what they are arguing against.
The other commenter already said, ought not to let the information wither on the vine. That's a reasonable take.
Second, "evidence-based X" is largely a euphemism and increased usage under political austerity. In Western society especially in academia by "medicine" we already assume some semblance of applied science, and so "evidence-based medicine" has been well critiqued in medical and other scientific literature, in relation to how institutions like hospital administrators and (austerity) state policies might misuse the term, etc. You are not aware of this issue, so just read some of the literature.
I’m in medical school and very aware, thank you for your condescension. Less important than my practical experience, I also have an academic degree in medical, health, and societal systems alongside my other more technical degrees. And none of my background even matters. This thread is just complaints all the way down with no actual practical solutions being mentioned. Frankly almost everyone in this thread has a fundamental misunderstanding of how the scientific process works in practice and isn’t even ready for a discussion about evidence based medicine. I’m not even a die-hard supporter of EBM, I think it has several apparent failures some of which are in this thread, but I do believe it is the best approach we practically have. I also don’t believe a collection of N=1 anecdotes means we should dismantle everything the past century in medicine has brought.
If you want a real conversation, every other alternative system of medicine has failures far worse than EBM. Which is why you don’t see practical solutions being offered anywhere in this thread just anecdotes and feelings about how the system has failed X or Y.
People don’t understand EBM is a consolidated approach to prevent anecdotal data from a single person destroying the lives of millions. Other non-scientific systems like Ayurvedic medicine are particularly susceptible and fail in multiple ways due to anecdotal data. Any holistic approach to medicine will necessarily include EBM such as an MBE or personalized approach, because holistic approaches cannot generalize research at scale. But nowhere in this entire thread do I see even a single named mention of an alternative or holistic system. Just anecdotes all the way down.
And you still didn’t answer my question. At least explain what an alternative would look like or give me a paper or link to educate my ignorant self. Instead of just saying “read some literature” like a conspiracy theorist and calling me ignorant.
It's great that you're in medical school and very aware, but that doesn't make it ok to break the site guidelines, which you unfortunately did repeatedly in this thread.
Sorry, I was definitely snarky in my comments and if I could edit my comments to remove the snark and change the tone I would.
However, your "It's great that you're in medical school and very aware" is very patronizing and pointedly dismissive. Its a superficially polite acknowledgment that feels sarcastic rather than genuinely complimentary. I don't really mind, and I acknowledge the point you're trying to make. But if your goal is to curate a curious discussion and avoid snark you should model it too.
It's all too easy to fall into, and we do it too. In such cases it's good when people point it out, and I'm happy to take my own medicine.
The fix is to be more mindful of how easily this happens and edit one's comments to err on the side of unsnark. That's what I will do. If you're willing to do that as well, then HN will be better off in both cases.
(I do think it's great that you're in medical school and willing to share some of what you know on HN, but I shouldn't have singled out the "very aware" bit - that was me being passive-aggressive.)
Your are projecting. Don't use my comment to complain about other people in this thread. If you had the cognizance to refrain from that, I would not appear to be so condescending to you. You may be in the field but if you can't be arsed to read a couple articles critiquing "EBM" then nothing will expand your understanding. You are using the boomer sophistry of "but nobody has solutions", "capitalism is the least bad system" nonsense. You talk about science at length but act like one of those EBM managerialists. It is evidently more political than science if you are so mad at me:
