Re: Book review: O.S. Miettinen: Up from clinical epidemiology & EBM

Excerpt

In a logical sequence of progressively deduced propositions and principles, Dr. Miettinen attempts to re-orient medical academia to the theories underlying clinical research in his recent book Up from Clinical Epidemiology & EBM (Evidence Based Medicine) [1]. This ambitious avant-garde text first examines the role of medical academia and criticizes—perhaps too harshly at times—the current ways of achieving knowledge about diagnosis, etiognosis, and prognosis in clinical medicine. Currently lacking for clinicians is an immediately applicable scientific knowledge base of clinical practice. Instead, in the current clinical epidemiology culture, practitioners are advised to spend lengths of time critically appraising literature on particular topics, form their own opinions on it, and use their uncodified experiences and varying opinions to make clinical decisions. The aim of EBM to standardize clinical practice is stymied by the process currently required to employ EBM. Exacerbating the problem are widespread imperfections in designs of clinical studies. For these reasons and others, Miettinen argues that EBM is a fallacy, “a cult movement…at variance with the essence of science and the imperatives of professionalism in medicine.” …