Evidence over Eminence in Medicine and Healthcare

Recently I’ve been sitting in many meetings in which I am amazed as to the lack of science and evidence when it comes to ideas in medicine and healthcare in general and healthcare IT specifically. It’s mind-boggling sometimes that people can nod their heads in agreement with a well known expert or authority in a field even if they say silly or downright stupid things from a scientific point of view.

Every time I hear someone pontificate without basis in fact or consensus evidence it reminds me of Dr. Joseph Bormel’s comment in one of my postings from a couple of years ago about evidence based medicine:

Perhaps the thrust of EBM was to favor evidence over eminence. Eminence is a source of power (role, relationship, and expertise being the three). In healthcare, we’d rather have maximal certainty of the right or best decision. That means evidence where it exists; where it doesn’t, maximizing certainty that best available evidence has been factored in.

He couldn’t have been more right about eminence.

I loved the “evidence over eminence” line so much that I use it all the time when I’m talking to physicians, architects, or anyone else that starts to pontificate.

Have you ever heard people say the following?

  • “I’ve been practicing medicine for 15 years and I have never seen that work – trust me.”
  • “I’ve been writing code for longer than you’ve been alive; that will never work – trust me”
  • “But, famous doctor so and so says that will never work so we shouldn’t try it – why bother?”

I bet you have.

Anytime you hear someone talking more about themselves and their experience or someone else’s opinion about a matter than about the evidence it’s a clear sign that their argument is about to go south. Since the Obama Administration is now in place and change is in the air, I recommend everyone start using the following question early and often:

Is your argument based on eminence or evidence?

Even if we think someone is smart or “really famous” or even experienced, let’s ask demand evidence. If they can’t supply evidence specifically for their argument (it may not exist) ask them for evidence from other industries or related fields. If they can’t supply even that much evidence then let’s have them admit they’re making an eminence argument, not a rational evidence-based one.

Oh, and if you’re a pontificator (like me) try starting some sentences like “The XYZ evidence shows…” instead of “In my experience I have seen…” 🙂

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9 thoughts on “Evidence over Eminence in Medicine and Healthcare

  1. Shahid,
    There’s an amusing yet telling article in BMJ regarding the alternatives to Evidence-Based decision making here:


    and summarized in this table:


    In case WordPress chews up the URLs above, just google this string “evidence eminence vehemence eloquence providence diffidence nervousness confidence” It will take you to the BMJ article; the table elaborates Markers and Measuring device. Again, it’s tongue-in-cheek, similar to how Jon Stewart on the Daily Show is “just kidding.”


  2. I can relate to what you are saying here. EBM sounds very nice in theory but from my past experience (yes showing off my eminence 😉 on implementing guidelines in EHRs its been a tremendous challenge. There are so many “ifs” and “buts” that an evidence collected doesn’t match the given situation of a patient and hence eminence or experience is the best resort to make decisions.
    I think its the same deal with Obama and the current administration – what we are seeing is unprecedented – there are no best-practice guidelines that the administration can follow to get us out of this mess.

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  4. Excellent post, very thought provoking. It is good to be aware of our internal bias towards eminent doctors or lawyers or even rugby heroes. Show me the evidence will be my inspiration for 2009

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