In Saturday’s’ Globe and Mail there was an interesting article by André Picard about the career of Dr. David Sackett, who pioneered the practice of evidence-based medicine (EBM). EBM promotes the idea that rather than just relying on tradition or expert opinion in medical diagnosis, the proper approach is to find available evidence and then attempt to apply it. This idea seems to make great deal of sense.
I knew little about EBM before I read the article, however, the concept of evidence-based practice (not necessarily as it applies to medicine) is something I have been thinking about for awhile. The EBM concept can probably be applied to all sorts of things.
EBM is based on the primacy of empirical findings, as opposed to other forms of reasoning. Evidence, as I understand it, forms the foundation of the scientific revolution of the 17th century, following the work of Francis Bacon, René Descartes and others. Evidence is at the root of science. If there is no empirical evidence then there is no science.
What was interesting about the article is that initially EBM was a controversial idea. It sounds like it remains controversial in some circles. This is surprising. Naively, you might think that EBM would be welcomed with open arms everywhere. For those with no background in medical diagnosis, it is difficult to conceive of a credible alternative to EBM.
Why then was EBM controversial? The article quotes Sackett:
“…all the old guys rejected it [EBM] because it challenged them. All the young guys loved it because it gave them a way to challenge their seniors in a more polite way, instead of telling them they were out of date. In addition, people who are wed to certain policies, if they have already decide what the answer is for an individual or a community, the last thing they want to hear or see is evidence.”
As Sackett suggests, some factors that may impinge on the rational aspects of scientific practice are patriarchy: older men wanting to maintain their authority regardless of the evidence; careerism: people wanting to promote their careers; and indulgence of egos: placing personal egos above efficacy of treatment or quality of ideas.
Scientists usually try to project an image of rationality–that the scientific method forces them to work strictly from available evidence. This is obviously an idealized portrayal of scientific practice. The work of Popper, Kuhn, and Feyerabend shows how scientific practice can be much messier than the idealized portrayal would suggest. For those familiar with the history of science, it should come as no surprise that people working within scientific domains can sometimes be no more scientific than any other segment of the population.
Scientific evidence often works against our intuition. Evidence can reveal the strangeness and unpredictability of the world. The way the world works is often more complicated than we we usually feel it should be. Truth can often be counter-intuitive. If you rely more on evidence rather than on preconceptions of what ought to be true, then you have to deal with a more complex world.
In addition, there is always the possibility that what you feel you ‘know’ is built on incorrect ideas or theories. In this case, in order to move forward you may have to takes several step backward and perhaps revise fundamental scientific theories. The history of science is not a linear, progressive cakewalk towards the truth: there may be lots of creative destruction along the way.
Most fields, whether scientific or not, depend on evidence to some degree. Architects bring in evidence that suggests their designs will help rather than harm the communities in which they are situated, politicians use evidence to corroborate that their policies will have good consequences rather than bad ones, business people use evidence that their business plans will end in profitability rather than bankruptcy.
In any field this evidence can be manipulated, misrepresented or simply disregarded. Quite often there is available evidence to inform a decision but there is little desire to search for this evidence if the evidence may prove inconvenient for preconceived policies. Scientists are not the only ones who can behave unscientifically.
