EBM and lesser-known ABCD relatives

Among medical school staff and students, the hallways often ring with the question “what is the evidence-based medicine (sic) to support that conclusion?” Evidence-based medicine (EBM) has been validated over and over again as an important method of learning and teaching medicine. There are even whole journals devoted to this concept. But what we are facing is an insidious congestion from other lesser-known “-based medicines.”

Photo by: Sibbald-Kinmond

ABM has been around for the longest time. There are suspicions that Hippocrates himself even used this technique. You can tell it is in use when a sentence starts “I had a case…”. Another verbalizing method, often used by the old-timers, occurs with the following preface: “in my experience.” Actually, “anecdote-based medicine” used to be called “experience-based medicine,” but when evidence-based medicine surfaced, our great medical minds realized that we could not tolerate such congestion around the letter E and, thus, ABM was conceived.

BBM is on the verge of being eliminated. In our PC environment, it is frowned upon, although tempting, to use any of those vulgar and profane B words that we grew up with to describe our esteemed colleagues' knowledge of medicine.

CBM is the most challenging and the most popular form of practice. Naturally, I am referring to “corporation-based medicine” or “company-based medicine,” depending on which search engine you are using. This category belongs to the pharmaceutical industry, which feels it has to “properly” instruct physicians as to the most modern, up-to-date approach to the utilization of their medications. Here the time frame may vary markedly. It can be done over a 2-hour supper lecture period or it may take 5 minutes in the doctor's office where pamphlets and other free samples are dispensed. Less commonly, it has been known to take as long as 6 hours to truly understand the finer points of prescribing the relevant medication, but then you would have to be on a golf course.

Recently, I have become exposed to DBM. This often occurs in close quarters, usually around a table, but it may be more informal. What is needed is a high-enough decibel range to emphasize just how right you are and, more important, just how wrong your colleague is. Thus, by speaking more loudly and thereby with more authority, you relay the obvious correctness of your medical perception to the other members of your department. “Decibel-based medicine” is having a re-SOUNDING resurgence and, unfortunately, is becoming very prevalent.

I have only touched on the first 4 letters of the alphabet. Those with more leisure time on their hands are more than welcome to pursue the exploration of the remaining alphabet possibilities. I, fortunately, have to go see my patients.