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The failure of evidence-based medicine?

Stephen Hickey, Andrew Hickey, Len Noriega


Evidence-based medicine (EBM) claims to provide gold-standard methods based on group and population statistics. However, the main issues in clinical medicine concern classification and prediction. During diagnosis, a patient’s illness is classified; then it is predicted that a specific treatment will be successful with that particular patient. Most scientific disciplines concerned with classification and prediction have rejected group and population statistics as being misleading, inadequate and inaccurate for such applications. This paper lists some of the critical findings from the decision sciences that bring the utility, application and validity of EBM into question. One of the foundations of EBM is that large clinical trials provide the best evidence. However, EBM misapplies the law of large numbers and best evidence really means selected data. EBM is inconsistent with modern science, theoretically unsound, impractical and erroneous in its application.

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[ ] Raman, R. (2011) Evidence-based medicine and patient-centered care: cross-disciplinary challenges and healthcare information technology enabled solutions. International Journal of Person Centered Medicine, 1 (2) 279-294.

Hickey, S. & Roberts, H. (2011) Tarnished Gold: The Sickness of Evidence-based Medicine. CreateSpace.

Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Ashby, W.A. (1960). Computers and decision making. New Scientist, March 24, 746.

Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B. & Richardson, W.S. (1996) Evidence based medicine: what it is and what it isn't. British Medical Journal 312 (7023) 71-72.

Bland, M. (2009). The tyranny of power: is there a better way to calculate sample size? British Medical Journal 339, 1133-1135.

Feller, W. (1971). Law of large numbers for identically distributed variables. In: An Introduction to Probability Theory and Its Applications, vol 2, 3rd ed, pp. 231-234. Oxford: Wiley.

Feller, W. (1968). The Strong Law of Large Numbers. In: An Introduction to Probability Theory and Its Applications, vol. 1, 3rd ed, pp. 243-245. Oxford: Wiley.

Hayek, F. (1945). The use of knowledge in society. American Economic Review XXXV, 4, 519-530.

Beinhocker, E.D. (2006). Origin of Wealth: Evolution, Complexity, and the Radical Remaking of Economics. Boston: Harvard Business School Press.

Weibull, J.W. (1997). Evolutionary Game Theory. Cambridge MA: The MIT Press.

Casti, J.L. (1979). Connectivity, Complexity and Catastrophe in Large-scale Systems. Oxford: John Wiley & Sons.

Albert, R. & Barabási, A. (2002). Statistical mechanics of complex networks. Reviews of Modern Physics 74, 47–97.

Dorigo, M. & Birattari, M. (2007). Swarm intelligence. Scholarpedia 2 (9) 1462.

Wolfers, J. & Zitzewitz, E. (2004). Prediction Markets. Journal of Economic Perspectives 18 (2) 107-126.

Tayler, W.J. (2005). Preliminary identification of core domains for outcome studies in psoriatic arthritis using Delphi methods, Developing assessment methodology in psoriatic arthritis. Annals of the Rheumatic Diseases 64 (Supplement 2) ii110-ii112.

Shendarkar, A., Vasudevan, K., Lee, S. & Son Y. (2006). Crowd simulation for emergency response using BDI agent based on virtual reality. In: Proceedings of the 38th conference on Winter simulation (WSC '06). L. Felipe Perrone, Barry G. Lawson, Jason Liu, and Frederick P. Wieland (Eds.) pp. 545-553. Winter Simulation Conference.

Terzopoulos, D. (1999). Artificial life for computer graphics. Communications of the ACM 42 (8), 32-42.

McKelvey, B. & Andriani, P. (2005). Why Gaussian statistics are mostly wrong for strategic organization. Strategic Organization 3 (2) 219-228.

Wiener, N. (1948). Cybernetics or Control and Communication in the Animal and the Machine. Oxford: John Wiley & Sons.

Fukunaga, K. (1990). Introduction to Statistical Pattern Recognition, Second Edition (Computer Science & Scientific Computing). Amsterdam: Academic Press.

Pal, S.K. & Biswas, S. (2005). Pattern Recognition and Machine Intelligence, First International Conference, PReMI 2005, Kolkata, India, December, Proceedings, Springer.

Davies, E.R. (2005). Machine Vision, Third Edition: Theory, Algorithms, Practicalities (Signal Processing and its Applications). Amsterdam: Morgan Kaufmann.

Ballard, D. (1999). An Introduction to Natural Computation (Complex Adaptive Systems). Cambridge MA: The MIT Press.

Bender, E.A. (1996). Mathematical Methods in Artificial Intelligence. Oxford: Wiley-Blackwell.

Solomonoff, R. (1978). Complexity-based induction systems: comparisons and convergence theorems. IEEE Transactions on Information Theory 24 (4) 422–432.

Engelbrecht, A.P. (2007). Computational intelligence: an introduction. Oxford: Wiley-Blackwell.

Hankerson, D.C., Harris, G.A. & Johnson, P.D. (2003). Introduction to Information Theory and Data Compression, 2nd ed. London: Chapman and Hall/CRC.

Stigler, S.M. (1990). The History of Statistics: The Measurement of Uncertainty before 1900. Boston: Harvard University Press.

O'Rourke, K. (2007). An historical perspective on meta-analysis: dealing quantitatively with varying study results. Journal of the Royal Society of Medicine 100 (12) 579-582.

Mankiewicz, R. (2004). The Story of Mathematics. Princeton NJ: Princeton University Press.

Fisher, R.A. (1925). Statistical Methods For Research Workers. Edinburgh: Oliver and Boyd.

Robinson, W.S. (1935). Ecological correlations and the behavior of individuals. Journal of the American Statistical Association 30, 517-536.

Vogt, W.P. (2011). Dictionary of Statistics & Methodology: A Nontechnical Guide for the Social Sciences. London: Sage Publications.

von Neumann, J. & Morgenstern, O. (2007). Theory of Games and Economic Behavior. Princeton NJ: Princeton University Press.

Ashby, W.R. (1956). An Introduction to Cybernetics. London: Chapman & Hall.

Krippendorff, K. (2009). Ross Ashby’s information theory: a bit of history, some solutions to problems, and what we face today. International Journal of General Systems 38 (2) 189-212; correction 38 (6) 667-668.

Ashby, W.R. (1958). Requisite variety and its implications for the control of complex systems, Cybernetica 1 (2) 83-99.

Conant, R. C. & Ashby, W.R. (1970). Every good regulator of a system, International Journal of Systems Science 1 (2) 89-97.

Scholten, D.L. (2010). Every good key must be a model of the lock it opens. accessed 4 Nov 2011.

Powell. W.B. (2007). Approximate Dynamic Programming: Solving the Curses of Dimensionality. Oxford: Wiley-Interscience.

Marsland, S. (2009). Machine Learning: An Algorithmic Perspective. London: Chapman and Hall/CRC.

Duda, R.O., Hart, P.E. & Stork D.G. (2000). Pattern Classification. Oxford: Wiley-Interscience.

Hawkins, D.M. (2004). The problem of overfitting. Journal of Chemical Information and Computer Science 44 (1) 1-12.

Miller, J.H. & Page, S.E. (2007). Complex Adaptive Systems: An Introduction to Computational Models of Social Life. Princeton NJ: Princeton University Press.

Mareels, I. & Polderman, J.W. (1996). Adaptive Systems: An Introduction. Basel: Birkhäuser.

Marshall, B.J. & Warren, J.R. (1984). Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 16, 1 (8390) 1311-1315.

Feller, W. (1945). On the normal approximation to the binomial distribution. Annals of Mathematical Statistics 16 (4) 319-329.

Box, G.E.P., Hunter, J.S. & Hunter, W.G. (2005). Statistics for Experimenters: Design, Innovation, and Discovery. Oxford: Wiley Series in Probability and Statistics.

Matsumoto, M. & Nishimura, T. (1998). Mersenne twister: a 623-dimensionally equidistributed uniform pseudo-random number generator. ACM Transactions on Modeling and Computer Simulation 8 (1) 3–30.

Press, W.H., Flannery, B.P., Teukolsky, S.A. & Vetterling, W.T. (1992). Numerical Recipes in C: The Art of Scientific Computing, Second Edition. Cambridge: Cambridge University Press.

Heckman, J.J. (1979). Sample selection bias as a specification error. Econometrica 47 (1) 153-162.

Migdalas, A., Pardalos, P.M. & Värbrand, P. (2001). From Local to Global Optimization. Amsterdam: Springer.

Walsh, B. & Gillett, G. (2011). A post-structuralist view of evidence-based medicine (EBM):

what EBM contributes to philosophy. International Journal of Person Centered Medicine 1 (2) 223-231.

Solomonoff, R.J. (1964). A formal theory of inductive inference: parts 1 and 2. Information and Control 7, 1-22 & 224-254.

Hutter, M. (2007). Algorithmic information theory. Scholarpedia 2 (3) 2519.

Rathmanner, S. & Hutter, M. (2011). A philosophical treatise of universal induction. Entropy 13, 1076-1136.

Huff, D. (1991). How to Lie with Statistics. London: Penguin.

Merlin, T., Weston, A. & Tooher, R. (2009). Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'. BMC Medical Research Methodology 9, 34.

Hemingway, P. & Brereton N. (2009). What is a systematic review? What is Series. Bandolier, April.

Hickey, S., Hickey, A. & Noriega, L.A. (2009). Implications and insights for human adaptive mechatronics from developments in algebraic probability theory. Presented at the EPSRC UK Postgraduate Workshop on Human Adaptive Mechatronics (HAM), Staffordshire University, 15–16 January.

Taleb, N.N. (2007). The Black Swan: The Impact of the Highly Improbably. New York: Random House.

Juffer, F. & van IJzendoorn, M.H. (2005). Behavior Problems and mental health referrals of international adoptees, a meta-analysis. Journal of the American Medical Association 293, 2501-2515.

Porter, M. & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons, a meta-analysis. Journal of the American Medical Association 294, 602-612.

Barone, J.E. (2000). Comparing apples and oranges: a randomised prospective study. British Medical Journal 321 (7276) 1569-1570.

Higgins, J.P.T. & Green, S. (2008). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 February, The Cochrane Collaboration.

Kendrick, D., Coupland, C., Mulvaney, C., Simpson, J., Smith, S.J., Sutton, A., Watson, M. & Woods, A. (2007). Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews, Issue 1, CD005014.

Adams, N., Lasserson, T.J., Cates, C.J. & Jones, P.W. (2007). Fluticasone versus beclomethasone or budesonide for chronic asthma in adults and children. Cochrane Database of Systematic Reviews, Issue 4, CD002310.

Ferguson, T., Wilcken, N., Vagg, R., Ghersi, D. & Nowak, A.K. (2007). Taxanes for adjuvant treatment of early breast cancer. Cochrane Database of Systematic Reviews, Issue 4, CD004421.

Miller, C.G. & Miller, D.W. (2011). The real world failure of evidence-based medicine. International Journal of Person Centered Medicine 1 (2) 295-300.

Beer, S. (2004). What is cybernetics? Kybernetes: The International Journal of Systems & Cybernetics 33 (3-4) 853-863.

Shamliyan, T., Kane, R.L. & Jansen, S. (2010). Quality of systematic reviews of observational nontherapeutic studies. Preventing Chronic Disease 7(6) A133.

Yu, V.L., Fagan, L.M., Wraith, S.M., Clancey, W.J., Scott, A.C., Hannigan, J., Blum, R.L., Buchanan, B.G. & Cohen, S.N. (1979). Antimicrobial selection by a computer. A blinded evaluation by infectious diseases experts. Journal of the American Medical Association 242 (12) 1279-1282.



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