EBM-RIP

Another computing metaphor might be useful at this stage, but it points us in a very different direction. Based on the paradigm that pharma companies have to follow to obtain drug registration, we have assumed that guides to clinical practice have to be hierarchical and bureaucratically “quality assured.” This is most obvious in countries such as the United Kingdom (UK), where the state wishes to be the sole arbiter of how people are treated (in part because much health care is tax-payer funded but also because the state likes to assert control of health). The World Wide Web offers us another model of  (clinical) expertise, one in which the idea of a single central authority assuring the truth or falsity of statements has been replaced by a community—or cacophony, depending on one’s viewpoint—of voices. Here expertise is distributed, and the measures of truth are perhaps much more nuanced and fluid, subject to change as data and clinical experience changes. Curiously, it is this latter model, albeit using earlier methods of communication, that was the basis for the growth of scientific ideas and our interpretation of evidence about the world. It might be worth revisiting. Here