Lefty medical friend calls this the era of idiocracy
(media.kotakuinaction2.win)
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Evidence Based Medicine is exactly how it should be, but like every single other thing that's a great idea, you have to be able to totally and permanently exclude leftists from having any kind of power or authority or they'll destroy it.
Evidence based medicine as it is presently used is a bit of a weasel word to the lay person.
It is treated as synonymous with "proven medicine", but a statically powered outcome study is not truly proof, only evidence. A statistically significant result is still completely wrong >0-5% of the time. Mechanistic root cause studies are proof, and they don't need statistical analysis because if they are correct they are correct without fail. The vast majority of evidence based medical practice is just very carefully educated guesses.
In an ideal world it would be "proven medicine", but that is an almost impossible ask presently, we haven't proven how many of our drugs even work, especially for off-label uses. And they can't be been proven safe because that would necessitate a complete understanding of human biology to say it doesn't interact with any of those systems negatively.
Addendum - The biggest problem with evidence based medicine in a society that lacks sufficient integrity is how much easier it is to manipulate statistical data sets to give the result you want to than it is to fake a mechanistic proof that isn't extremely easy to prove false.
Well said.
Another concern with worshipping RCT trials and "expert" clinical guidelines as dogma is that it leads to conformity and treating populations over individuals.
Every patient with disease X is expected to be put on drugs Y and Z because a study said that it will prevent one "terrible outcome 1" if the 87 plebs pop the pill compliantly for 10 years straight.
But it's the needle-in-a-haystack problem that the 1 of 87 who will benefit can't be identified, while the other 86 are exposed to risk, cost and lack of autonomy for no benefit to themselves.