I had a fun chat with Professor Darrel Francis on Evidence-Based Medicine. Here are some of the highlights:
1:18 – I throw down the gauntlet on EBM.
4:01 – Dr. Francis proposes the analogy of the chocolate-made washing machine spinner.
6:15 – My come back: overuse is not due to a lack of RCTs but improper incentives. Dr. Francis on the reception of ORBITA in the UK versus the US: “They don’t get angry!” EBM as tool for rationing.
11:20 – Dr. Francis: “How is it possible for there to be a single number that God has implanted in the coronary artery and revealed it to Nico Pijls…that tells us the risk/benefit ratio of stenting that patient?”
18:00 EBM and the placebo effect.
24:-30:00 – “Shared-decision making” is a sham.
31:00 – On the harm to clinical judgment: “I don’t mind the E, but I don’t want the BM in my practice!”
33:00 – Dr. Francis on “Bogle’s Demon” and “A vulnerable plaque is a plaque that has a stent in it.”