Tarnished Gold by Steve Hickey and Hilary Roberts: EBM as An Avatar of Modern Medicine

Abstract

Despite many passing references to contemporary frontiers of thought such as cybernetics and complexity theory, Tarnished Gold, a self-published book, leads the reader towards critical visions of clinical research enterprise that are more linked to the past than to the present or the future. Along the way, Evidence Based Medicine is taken as the enemy, but is consistently misrepresented. The authors are seriously under-informed regarding contemporary issues and controversies related to the design of clinical research as well as the cognitive aspects of clinical practice. They ignore the relevance of narrative and relationship-centered medicine to those issues and controversies. The actual challenges of healthcare in our time and its relationship to clinical research are largely avoided. As a result, “Tarnished Gold” fails to illuminate or inform lessons already learned from the controversies that have occurred since the appearance of EBM. More importantly, the authors fail to observe that the terms of the debate between EBM and its critics have changed in the direction of an integrative approach, based on considerations of not only the logic of scientific inference, but of contemporary understanding of clinical reasoning and of the forms of knowledge that underlie it. Some of those terms are addressed by this review.