Monday, January 1, 2018

Evidence Based ⓡ

Evidence Based ⓡ


When I was a boy, many products advertised that they had The Good Housekeeping Seal.  Despite the battle between the Federal Trade Commission and the Hearst backed publication (1939) that implied that the seal was primarily an advertising gimmick, the Good Housekeeping Seal remained something that could be touted as a sign of  quality. 

In medicine, the seal of quality is called Evidence Based. The Evidence Based  label has come to  mean something close to "correct", something better- and at the same time,  not  as good as - true  Evidence is better than truth because it is a body of information that is  ( or should be) available for all to examine.  An evidence based conclusion is one that follows logically from the data, any rational, knowledgeable person would come to a similar, if not identical, conclusion.  But it is only as good as the data... and the interpretation. 

Evidence Based is  usually associated with  an  expert consensus opinion.  Very few practicing physicians have ever examined the evidence upon which the conclusion is based.  The evidence itself is rarely available.  Articles  that represent the conclusions of the authors, the people who oversaw the gathering of the evidence,  are the only readily available material that is derived from the evidence. The actual evidence is  in a silo, a private storehouse. 

Fifty years ago, handling numbers was out of the reach of most people.  Only engineers had calculators and  computers were rare.   At that time,  it made no  sense to supply raw, undigested  data to a broad audience.  Nothing could be done with it.  Who was going to copy long columns of numbers and do long divisions by hand?  But now, we all have powerful computers in our pockets and downloading vast amounts of data requires only a click.  But, the actual  data remains hidden.   And we call quoting the conclusions of the authors "evidence."  This is applying a veneer of science to an edifice of opinion. This is scientism.

It is clear that were such raw data available, few would have the time or the skills to independently analyze the data.  Opening the data to public examination could lead to misleading, incorrect analyses. The information could be politicized and reinterpreted for profit or the benefit of a particular cause.  Presumably the data had been open to the scrutiny of reviewers who share expertise in the field.

There are dangers in democratization of data.  I think they are worth the risk. Monolithic science is not the optimal solution.

Most importantly, when a conclusion is called Evidence Based or Data Driven, we should identify who analyzed the data...and who confirmed the conclusion. 

  


No comments:

Post a Comment