Is science the answer?

With Michael Keane. Published in BJA: British Journal of Anaesthesia, aex334, 4 October 2017

Abstract: Nearly ten years ago, Tobin described the irony that evidence-based medicine (EBM) lacks a sound scientific basis. A sentinel paper concluded that most results of medical research were false, and now the same author, a well-lauded EBM proponent, argues that even if true, most clinical research is not useful and now concedes that EBM has been ‘hijacked’ by ‘vested interests’ including industry and researchers.4 The community expends vast resources on research, yet it has been estimated that there is an 85% ‘waste in the production and reporting of research evidence’ … Should we continue with the same paradigm and expect better results? In this counterpoint, we argue ‘no’.

Available at Oxford Academic

Evidence-based medicine: A predictably flawed paradigm

With Michael Keane. Published in Trends in Anaesthesia and Critical Care (2016) 9, September, pp. 49-52.

Abstract: Is evidence based medicine the most appropriate paradigm for advancing clinical knowledge? There is increasing discussion of how evidence and science guides clinical medicine and the accumulating awareness that individualized medicine inevitably falls within a clinical gray-zone. Here we argue that the basic proposition that an analysis of historical data from controlled trials can objectively and efficiently decipher what treatments are uniformly superior is fundamentally flawed. We also argue in particular that in such a complex system as acute medicine it is predictable that randomised control trials will frequently lack the fidelity to give definitive or even useful answers, especially around the margin of progress.

Available at ScienceDirect or Academia (accepted manuscript)