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A Piece of My Mind
May 5, 2020

EBM’s Six Dangerous Words

Author Affiliations
  • 1Department of Population Health, New York University School of Medicine, New York, New York
JAMA. 2020;323(17):1676-1677. doi:10.1001/jama.2020.2855

The six most dangerous words in evidence-based medicine (EBM) do not directly cause deaths or adverse events. They do not directly cause medical errors or diminutions in quality of care. However, they may indirectly cause these adverse consequences by leading to false inferences for decision making. Consider the following statements, each of which includes the six most dangerous words:

• There is no evidence to suggest that hospitalizing compared with not hospitalizing patients with acute shortness of breath reduces mortality.

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    2 Comments for this article
    Does Statistical Modelling & EBM Asphyxiate Intuition ?
    Alan Griffiths, D.O. | Retired Osteopathic Physician (private practice 40 yrs)
    Surely some of the greatest discoveries in the history of medical /biological science have occurred when someone at some time decided to experimentally do something for which "there was no evidence to suggest" that it should work, until they provided the evidence by doing it.

    Thoughtful article with some insightful recommendations. My preferred caveat from the four suggestions would be (2) “Scientific evidence is inconclusive, but my experience or other knowledge suggests ‘X.’”

    "EBM was never meant to exclude information derived from experience and intuition." While some may argue that misuse of this phrase is only
    a symptom of not having received appropriate training in EBM, my experience with practitioners of EBM across the clinical, educational, research, and policy spectra suggests the contrary.

    I for one can see no evidence to not suggest Dr Braithwaite is speaking candidly, therefore I definitely share & welcome his opinion.
    EBM Causes Harm
    Wade Harris, MD | Ansbach Army Health Clinic Germany
    As a physician who did general practice from 1981 to 1986 before becoming a psychiatrist I was horrified as opiates began being prescribed for chronic pain. We older physicians could not anticipate the huge number of deaths from opiates, but we universally believed that treating chronic pain with opiates led to poorer quality of life, not better, and we simply didn't do it. However, "there was no evidence" that opiate use for chronic pain led to addiction and poorer quality of life. There is plenty of blame to go around for the many thousands of opiate deaths, but EBM deserves a lot of the blame.