Tuesday, November 17, 2015

The Nonbelievers

I have to admit, I have an inherent bias.
And how it came to this I don't know. After all, I hated Evidence-Based Medicine (EBM) in medical school. I had a bully of a mentor, a lab-based cardiac physiologist with minimal people skills, who bluntly told me, "Your question was so stupid I'm not even going to try to answer it...." (digression: I'm not a model teacher- but I swore I would never speak to a student/resident like that ever. Words do scar). Anyway, I spent all of medical school fearing the word 'research', and hating everything EBM.
I went into residency with the same sentiments, feeling stupid, ignorant and inferior when you are in the company of the world's medical greats. The world-famous researcher clinicians whom patients travel the world over to see. Classmates who compare not only how many publications you have but what impact factor the journal that accepted your manuscript carried.
Research. Ugh.
And then something kinda slowly happened. After all, you do get brainwashed training at the same institution for six years. And not that I consider myself a brilliant researcher, but at least I learnt some of the ropes. I learnt what it takes to write a paper, analyze a study, even perform experiments (I got to play with human orbital fibroblasts, yay!). And I popped my publication cherry. And became a scientist. I still consider myself one- after all, a doctor is a person of science, and as dynamic as science can be, we too need to evolve and learn, don't we? And so, it's interesting how I went from that hater of EBM in 1999, to one who looks at The Evidence, to guide his clinical judgments. Not only the conclusions of the study, but also to try to pick apart the study to see if he agrees with the findings. After all, the goal of an author is to get the study published, and one often learns to present the data in the most compelling way; so you can't always take things at face value. And so, yes, I'm a believer of EBM, I think we all should be.
That being said, I've realize that the world doesn't see things that way. For some, EBM remains a bad word, one that is controlled by Big Pharma who makes things up to fool doctors and ultimately patients, all in the name of making money. And I've realized that once a person chooses to not believe, there is no amount of data you present that will be accepted, that they always will view things with a generous serving of skepticism. That big pharma bought you/CDC/FDA over- never mind that the basic concept of EBM is that you learn to critically appraise and make your own decisions.
This is perhaps more worrisome when the person you're trying to convince is a medical professional. I ran into this situation when discussing a case with a surgeon, when he (in my opinion) was over treating a patient with an unjustified therapy based on an unproven diagnostic test (which incidentally enough, is something he owns too).
And so sometimes, there is only so much you can do. And sometimes, you just have to take a step back, and agree to disagree. But secretly you hope the patient takes your side, because the data really doesn't show that that treatment is necessary.