Evidence-Based, Eminence-Based and Eloquence-Based Medicine

Evidence-based medicine has grown in acceptance in recent years as the preferred method of decision making in healthcare for clinical and policy situations alike. Through the use of tools and approaches such as systematic reviews and meta-analyses and the emergence of groups such as the Cochrane collaboration, it is easier than ever for  clinicians and health policy makers to incorporate evidence-based medicine into their daily practice. Admittedly, there are some limitations to evidence-based medicine (ie. studies which are not published are not included in systematic  reviews) and some skeptics remain, yet overall most would agree that we need more, not less, evidence-based medicine.

In preparing for a lecture in my rural health policy analysis course this past week, I rediscovered a hilarious article from  the British Medical Journal, Seven alternatives to evidence based medicine. 1 Each year near Christmas, both the  British Medical Journal and the Canadian Medical Journal publish a number of satire pieces and this article was one such piece published in 1999. I won’t include all seven alternatives in this blog, but here are my two favorites from the article:

Eminence based medicine – The more senior the colleague, the less importance he or she placed on the need for  anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a  touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence  over an impressive number of years.” The eminent physician’s white hair and balding pate are called the “halo” effect.

Eloquence based medicine – The year round suntan, carnation in the button hole, silk tie, Armani suit, and the tongue  should all be equally smooth. Sartorial elegance and verbal eloquence are powerful substitutes for evidence.

Do you work with any clinicians or healthcare decision makers who fit these descriptions? Do you have any other  suggested alternatives to evidence-based medicine?

1. Isaacs D, Fitzgerald D. Seven alternatives to evidence based medicine. BMJ 1999; 319: 1618.