Oh, is that what you think evidence-based medicine is?

In the most recent EconTalk episode, Russ Roberts interviewed Eric Topol about how technology (mostly genetics) could revolutionize medical care. This post should not be interpreted as a critique of the entire discussion. It’s largely fine. But something struck me as odd.

Early in the hour, Russ defined “evidence-based medicine” as doctors providing therapies based on tests. The test results are the evidence and the therapies are the medicine. Do many people think that’s what “evidence-based medicine” means? It has never occurred to me to think of it that way. In fact, doing so does a disservice to evidence.

I always think of “evidence-based medicine” as health care decisions informed by credible evidence of benefits and harms. In fact, evidence doesn’t determine what care is delivered. It’s always a judgement call whether the benefits outweigh the harms and/or the cost (yes, somebody, somewhere is making a cost-based decision even if it is implicit and by default). Ideally, decisions are both informed by evidence and consistent with patient values.

Later in the program the discussion turns to treatment of ear infections. The thought experiment is that there is a novel gadget that permits the diagnosis of ear infections without a human and with high accuracy — a very good test. Topol then suggests that an antibiotic might be prescribed automatically if the gadget detects infections. Is that evidence based medicine because the (accurate) test detects an infection?

No! Ear infections almost never require antibiotics. They certainly should not be prescribed routinely. Knowing that is what evidence-based medicine is about. It’s not knowing the results of a test.


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