The most popular item on the TIME magazine Web site at the moment is a survey of how evidence-based medicine is starting to displace doctors' hunches. The article implicitly illustrates how (to use religious language) we're far better off when we give priority to the reality that God actually wrought, rather than clinging to our limited conceptions of that reality. To paraphrase the Rev. Barbara Brown Taylor's definition of 'faith,' it's a Very Good Thing to remain open to the truth, no matter what the truth turns out to be.
Increasingly, doctors seeking to provide their patients with the best possible care are exploring what is known as evidence-based medicine--a hard, cold, empirical look at what works, what doesn't and how to distinguish between the two. It's not enough to prove that a particular blood test or CT scan really spots cancer, for example. You also need to know whether early detection of that cancer would make a difference in your ability to respond to treatment or it merely means that you would die at the same point but learn about your illness earlier than you would have without the test.
Evidence-based medicine, which uses volumes of studies and show-me skepticism to answer such questions, is now being taught--with varying degrees of success--at every medical school in North America. It has been extraordinarily successful in shooting down some of the most cherished beliefs in health care, like the idea that long-term hormone-replacement therapy would help prevent heart disease in women. And it has clearly saved lives. Many doctors used to give anti-arrhythmia drugs to everyone who experienced irregular heartbeats after a heart attack because severely irregular beats could rapidly prove fatal. But then came the results of a randomized trial showing that patients with only mildly irregular heartbeats were more likely to die if given the anti-arrhythmia medication than their untreated counterparts were. Doctors now prescribe more judiciously, though treatment still saves lives in the case of severe arrhythmias.
[...] Physicians who encouraged their female patients to take hormone-replacement therapy to prevent heart problems later on were practicing a kind of evidence-based medicine, since the best available evidence at the time--observational studies and the like--suggested a benefit. Of course, when a randomized controlled trial showed otherwise, the advice changed. Even at that, the case is not entirely closed. Some researchers now believe there may be a window of opportunity right around the years of menopause during which hormone-replacement therapy could help the heart. Proving that would, naturally, require another study.
All the same, few people deny that the trend in medicine is increasingly to be guided, if not governed, by the data--an idea that is spreading to other fields as well. Evidence-based practice is now being taught in nursing, general education and even philanthropy, thanks to the influence of the Bill and Melinda Gates Foundation, a results-based group if ever there was one. You could see even the political fights over global warming as the birth pangs of the new practice of evidence-based policy.
Christine Gorman, Are Doctors Just Playing Hunches? in TIME, Feb. 15, 2007