Evidence-Based Medicine:
A Socratic Debate


Due to the power and corrupting influence of Big Pharma, the teaching
of nutritional science and the use of vitamin and herbal supplements is
not taught to any significant extent in our medical schools. The obvious
reason is that teaching this science reduces the use of prescription drugs.

February 22, 2013 -- A delightful article on Dr. Larry Alexander's new web site called EyeLessons.com reminded me of my 2007 Friday Pearl on Socratic debate borrowed from a 1995 British Medical Journal. We hope you will enjoy reading it, or rereading it if that's the case.

SOCRATES: Tell me, Enthusiasticus (Meta-analyticus); they say you are espousing a new form of medical practice. Is that so?

ENTHUSIASTICUS: Indeed Socrates, and very effective it is.

SOCRATES: Does it have a name or description?

ENTHUSIASTICUS: Yes, we have called it evidence-based medicine.

SOCRATES: How very interesting! But I do find the title that you have given this new form of medical practice rather alarming. I thought that all doctors were trained in the scientific tradition, one tenet of which is to examine the evidence on which their practice is based. How then does this new evidence-based medicine differ from traditional medicine?

ENTHUSIASTICUS: Well, Socrates, one problem is that most doctors have a very narrow perspective, limiting themselves to their own experience and that of a relatively few colleagues (or journals) with whom they exchange views or gather information. This sometimes leads them to make erroneous conclusions.

SOCRATES: Do you imply that in their narrowness they fail to search for evidence which might cause them to reach a different conclusion or allow them to come to a more balanced decision?

ENTHUSIASTICUS: Precisely, Socrates, you have hit on it.

SOCRATES: How do you, Enthusiasticus, manage to gain access to this evidence which more ordinary doctors find inaccessible? Is it hidden away?

ENTHUSIASTICUS: Sometimes it is. We have sophisticated methods using information technology for searching out the efficacy of treatments from all over the world. Also scientists and doctors don't always publish the results of their studies, particularly if they have been negative. My colleagues and I have ways of unearthing these results, which can on occasion change views about the efficacy of a treatment.

SOCRATES: What is the cause of this reluctance to publish negative results? Is it because the science is poor?

ENTHUSIASTICUS: No, the science is often quite good, but journals, authors, those funding the study and even some readers aren't always interested in negative conclusions; things are much more interesting if they turn out positive. (FYI Socrates: passionate medical writers can often sniff out buried studies as efficiently as French pigs find truffles.)

SOCRATES: So, Enthusiasticus, sentiment still holds sway in medicine.

ENTHUSIASTICUS: What do you mean?

SOCRATES: I have often wondered about the application of the null hypothesis to studies planned to find out if a new treatment works.


SOCRATES: Should it not be the purpose of the null hypothesis to assume that the new treatment is no better than the old treatment or even no treatment at all? This is then the beginning of the application of statistical theory to the practical problem.

ENTHUSIASTICUS: I had no idea you were so well versed in statistical theory.

SOCRATES: I am not. The null hypothesis is just common sense. Statistical theory is, however, something else. My point is that I have never met a doctor who practices medicine in full accordance with the null hypothesis, nor, and this is more pertinent, one who applies it completely dispassionately to the investigation of the efficacy of treatments. All the doctors I know hope very much that their new treatments will work, whether it be in individual patients or in groups of patients in a clinical trial. Is it really possible to theorize on the question of proof of efficacy by one set of rules but approach the practical aspects of clinical testing of treatments by another?

ENTHUSIASTICUS: Well, that is the exact purpose of the double blind, randomized clinical trial: to remove from clinical studies the bias produced by just these motives you describe.

SOCRATES: So is this evidence-based medicine going to fundamentally change the way doctors view their treatments?

ENTHUSIASTICUS: Not essentially, but it will help doctors take a wider view of the results of clinical trials and practice and avoid the tendency of doctors to rely too much on their own limited experience, which may be flawed because of its numerical inadequacy and biased recollections. We have developed statistical methods and reasoning to enable us to take a dispassionate overview of the results of a given medical practice.

SOCRATES: This seems admirable to me. I cannot understand why doctors might choose to practice by a method based on inadequate personal impressions rather than the more objective and comprehensive method you describe.

ENTHUSIASTICUS: Perhaps it is because personal experience in medical practice has such a strong influence on a doctor's future actions.

SOCRATES: Is this an expression of the conflict between the science and the art of medicine?


SOCRATES: Does it apply equally to the matter of diagnosis as much as treatment?

ENTHUSIASTICUS: Why do you ask?

SOCRATES: Because my physician friends are always emphasizing to me how important experience and pattern recognition are in the making of a good diagnostician. Do you agree with that?

ENTHUSIASTICUS: To a great extent I do, though there are areas of diagnosis which can be improved by the application of the methodology I have described in respect of treatment assessment.

SOCRATES: Is this difference between the impact of personal experience on the diagnostic art, or is it a misleading influence in the appraisal of practice outcome, emphasized during the education of young doctors?


SOCRATES: What do doctors learn first and what aspects of medicine are most emphasized during medical education?

ENTHUSIASTICUS: Undoubtedly all those matters that aid the accurate diagnosis of disease.

SOCRATES: A strong part of which is this experiential aspect?


SOCRATES: Perhaps then, the young pick up the experiential art of diagnosis from their teachers and mistakenly hope to apply the same approach to treatment, which as you have explained would lead to bad habits.

ENTHUSIASTICUS: I shall have to think about that.

SOCRATES: Tell me, do you yourself apply the fruits of your evidence-based labours?

ENTHUSIASTICUS: Unfortunately not. I am so busy applying this new methodology to the appraisal of medical practice that I no longer have time to see patients myself.

SOCRATES: I sympathize. I spend so much time in critical philosophy of an abstract nature that practical application of it has become impossible. I must warn you though that your colleagues, like mine, might not always appreciate your good intentions. Even now my detractors are planning to put me on trial for subversive thought. You must see that if you yourself are not constantly versed in the infinite variables of patient presentation and response to treatment, and dealing with them every day, you will be prey to criticism from those who do.

ENTHUSIASTICUS: I have recently become aware of that and I am unsure how to deal with it. The matter is particularly acute because the cause of evidence-based medicine has been taken up by those who now manage our medical practice.

SOCRATES: What is their interest?

ENTHUSIASTICUS: They are particularly anxious to get value for money and wish to be sure that doctors' actions are effective and worth paying for.

SOCRATES: So there must be a large number of doctors practicing cost ineffective medicine for such a grand scheme to be enacted.


SOCRATES: Those are words I would never have expected to hear pass your lips. That aside, however, are you sure that the motives of the doctors are as pure and intellectual as you imagine?

ENTHUSIASTICUS: How could it be otherwise?

SOCRATES: Is it not the health care manager's job to ensure that health care is delivered in the most cost effective way possible? And do not all politicians exhort managers to get the best bargain?


SOCRATES: Then what do they perceive as the main barrier to their purpose?

ENTHUSIASTICUS: Lack of evidence as to what is really effective.

SOCRATES: It would be nice, Enthusiasticus, my gullible friend, if it were really so, but I doubt it. The main barrier they perceive is an archaic medical profession spending their money in a profligate manner. They see your beloved evidence-based medicine as a means to shackle the doctors and bend them to their will. That, I am certain, is why they are so enthusiastic about it. Beware, Enthusiasticus, that you are not used as a dupe in a political game of healthcare economics. Remember, hemlock may be down the line. (See The Age of Pharmageddon.)

Ellen Troyer, MT MA
Biosyntrx CEO/Chief Research Officer --

Helpful Health Hints


Pages And Points To Ponder








About Hair

Eyes Have It

Ear Candling

Back Walking


The Water Cure

Inner Clean Diet

What About Gout

For Women Only

The Human Body

For Garlic Lovers

Sugar Is A Poison

Reflexology Chart


What's Eating You

Yogi Bhajan's Diet

The Oreo Dilemma

Vegetarian Recipes

Food Ads vs. Reality

A Healing Meditation

Drinking Driving Dead

Test Your Eyes Online

Beware: Canned Soup

Notes From Your Liver

Meditation For Women

How To Reverse Aging

Sugar Dumbs Us Down

What About Gallstones

What About Chemtrails

What About Aspartame

The Color of Depression

Beware: "No Added MSG"

Do Doctors Cause Dementia

Texting And Driving Is Crazy

It's Time To Rag On Ragweed

What About Sodium Benzoate


Left Brain-Right Brain Diversity

Be Warned If You're On Statins

The Aquarian Age Wake Up Call

10 Warning Signs of Alzheimer's

Lasik Eye Surgery - FDA Warning

Drug Company Insider Confesses

Corporations are killing Americans

A Critical Look At Optical Retailers

Jimmy Carter And Women's Rights

What Your Optician Needs To Know

Is Alzheimer's Diabetes of The Brain

Appendix: A Newly Discovered Organ

Another Side of The Soy-Protein Story

See What Happens When You Meditate

See Why Sikhs Keep Their Hair Unshorn

What About PPA (PhenylPropanolAmine)

Use Himalayan Salt - Do Not Use Table Salt

Opticians: Merchants or Health Care Providers

Your Health By DaSign    Other Views

 Cleansing Diet    Meatless Is Better

More Web sites by

SAAAP.org Dieterata.com
AllIsOne.guru HariSingh.com
TheISites.com SikhTribes.com
SopaSeca.com SikhSongs.com
UbuntuAge.com WaheGuru.guru
UntoInfinity.com NarayanOil.com
LeftOfMaya.com SikhsShine.com
EyesOnPies.com Turbanators.com
SikhAnthem.com IsolatedSeer.com
BroadPoints.com 13EkOngKar.com
Obama43To1.com SoothingSpa.com
HariKaurBird.com ChardeeKala.com
OpticalViews.com 2020ForEyes.com
KhalsaVision.com SPIRITofGRD.com
GuruRamDas.com LakeKillarney.com
DualityOptics.com HariSinghBird.com
Interior-Guard.com SatKartarSingh.com
OpticalCourse.com DrRamonIbarra.com
MiriPiriWarrior.com FitItAndForgetIt.com
1IsTheAnswer.com OpticianryToday.com
SatNamMeans.com WordPhysiology.com
KaliYugaSigns.com JustAddedWater.com
SiriSinghSahib.com EyewearMoodys.com
1And1Equals11.com PreetKaurKhalsa.com
CloseOrderDrill.com WhiteTantraYoga.com
RamDhanSingh.com 3HOLegacyLinks.com
2020ForWomen.com TheMahanTantric.com
HangupsByHari.com SiriMantraForLife.com
ACTForDiversity.com OpticianryReview.com
AdiShaktiMantra.com 2020ForOpticians.com
ScienceOfMudra.com OpticalGuidelines.com
OneIsTheAnswer.com GuruGobindSingh.com
ScienceOfMantra.com OpticalWorkshops.com
GuruGaitriMantra.com KirpalSinghKhalsa.com
OohRahMemorial.com SimranKaurKhalsa.com
AkalCommittee13.com SadhanaGuidelines.com
GurdwaraSecurity.com YouAreTheEssence.com
AmarSinghKhalsa.com KundaliniYogapedia.com
DiversityDialogues.org StFrancisOfficePark.com
SensitivitySummit.com ToTheSweetestMom.com
AwtarSinghKhalsa.com YogiBhajansTeacher.com
SurvivalCampUSA.com OpticalShiftHappens.com
KhalsaWebMasters.com AllForOneWonForAll.com
MasculineMoments.com DrinkingDrivingDead.com
AhaMomentOfTruth.com MyInterviewWithGod.com
HairInLaysTheTruth.com SaTaNaMaMeditation.com
PartnersNotParents.com FaceBlindnessIsReal.com
ToTheSweetestWife.com ToServeIsToSucceed.com
EachMomentIsAGift.com ServingVersusSelling.com
SikhAndYeShallFind.com SukhmaniKaurKhalsa.com
OpticiansForChange.com LakesideManorOnline.com
HappinessIsTheRule.com EyeWearProfessionals.com
AtTheFeetOfTheYogi.com SecurityAdvisoryTeam.com
SiriGuruGranthSahib.guru ReligionDemographics.com
RaMaDaSaMeditation.com TimeForCraftsmanship.com
UniversityOfDiversity.com FirstSikhOfSikhDharma.com
DispensingGuidelines.com HealthEqualsHappiness.com
CourageousDialogues.com GoodGuysWearTurbans.com
SatKriyaByYogiBhajan.com AquarianAgeBeganHere.com
IfYouKnowWhoYouAre.com ButterflyEffectExplained.com
EyeExaminationOnline.com FirstTeachersAreWomen.com
GlassesOnlineWarning.com SugarIsAFourLetterWord.com
IDoNotEatDeadAnimals.com SikhWomenWearTurbans.com
MoreThanYouCanKnow.com WomenWimpsOrWarriors.com
OpticiansForThePeople.com CosmicCyclesAndCircles.com
OnsiteFamilyHealthcare.com TheAfterDeathExperience.com
SantSipahiAdvisoryTeam.com IAmABornAgainAmerican.com
KirtanKriyaByYogiBhajan.com TestYourKnowledgeOnline.com
SatHanumanSinghKhalsa.com LifeAccordingToYogiBhajan.com
TextingAndDrivingIsCrazy.com NowYouKnowThatYouKnow.com
ItsAllAboutMeNotAboutYou.com KundaliniYogaByYogiBhajan.com
CrucifixionByAnEyewitness.com EndOfPrideAndPrejudiceIsNigh.com
GodAndMeMeAndGodAreOne.com EkOngKarSatNamSiriWaheGuru.com
ReachOutAndTouchSomebody.com TheTechnologyOfConsciousness.com
ConsciousCommunicationGuidelines.com OneIsTheAnswerWhatIsTheQuestion.com

joomla statistics

  *Consultation with a health care professional should occur before applying adjustments or treatments to the body, consuming medications or nutritional supplements and before dieting, fasting or exercising. None of these activities are herein presented as substitutes for competent medical treatment. See Disclaimer.

© All rights reserved.