Evidence‐based medicine and limits to the literature search

Abstract

With examples from signal theory and decision theory, the literature search is analyzed in light of fundamental limits in the nature of informaiton. You can run from expertise but you cannot hide. Expertise is inevitably required to deal with these errors. So do-it-yourself searching is inadequate in the absence of expertise. The best decisions result from collaboration with subject matter experts and decision-making experts.

Evidence‐based healthcare, clinical knowledge and the rise of personalised medicine

“…Thus, the outbursts of rhetoric and triumphalism that characterised the inception of EBM have essentially (though not completely) ceased and few EBM enthusiasts now recommend the initial 5‐step [284] or 6‐step [285] technique. Instead, EBMers go more quietly about the business of promoting their creed [332] and have substituted the ideal of the individual clinician as searcher, appraiser and applier of literature‐based clinical data, for the figure of the individual follower of evidence digests prepared by EBM groups strictly in accordance with EBM's reductionist understanding of clinical science and medical practice [43,44]. No attempts have been made to address the lack of a theoretical base for EBM, despite their urgent necessity [1], nor to address the complete lack of evidence that EBM is superior in terms of its outcomes to so‐called conventional Medicine [1]– a factor which invalidates the EBM thesis in accordance with its own rules.…”

“…In his article on ‘Evidence‐based medicine and limits to the literature search’, Robin Nunn [43] is clear that searching the literature – a core requirement of the initial and continuing EBM methodology – has been impossibly oversold in an attempt, he feels, to circumvent individual expert authority. But for Nunn, as for us, the more information there is, the more expert authority is needed – a contention that is not simple ‘philosophical musing’, but rather based on a proper understanding of the fundamental nature of information itself.…”

“…Miles notes that this concession from the original posturing [12] has been a major one, but that it continues to represent nothing more than a further example of the serial reconstitutions (rather than slow, thoughtful, evolutionary development in thinking) that have characterised the short history of EBM and which are sure to be documented with comment by the History of Medicine. Notwithstanding these concessions, there appears for the protagonists of EBM to be 'an odd distinction between "evidence" from an expert and "evidence" from a literature search, as if they are somehow different species of authority, incapable of interbreeding' [43]. For Miles [44], the observations made by some that EBM is not against expertise per se, but rather that it values different types of expertise differently, therefore appears unsupportable.…”

Evidence for practice and the authority of experts: there can be no former without the latter: a commentary an Nunn (2008)

“…In this, the 11th thematic edition on evidence‐based medicine (EBM) of the Journal of Evaluation in Clinical Practice , Nunn [1] contributes his paper Evidence‐based Medicine and Limits to the Literature Search . Nunn's fundamental thesis is clear – EBM has traditionally relied (and still does rely) on individual clinicians searching primary electronic database located literature, or at least consulting secondary sources such as so‐called EBM reviews of the primary literature formulated in strict accordance with the EBM mindsets and processes as initially observed and promulgated [2–4].…”

“…This concession (and it was a major one) represents only one of the serial reconstitutions of EBM to which I have already referred above and which is considered more broadly in the Editorial Introduction and Commentary of this Thematic Edition [12]. Curiously, and as Nunn observes, there nevertheless continues to be, for the protagonists of EBM, ‘an odd distinction between “evidence” from an expert and “evidence” from a literature search, as if they are somehow different species of authority, incapable of interbreeding’[1]. Not that Nunn at any time advocates deference to expert authority as the primary or an infallible source of ‘best’ judgement.…”