Last week’s TIME Magazine has an excellent article about a very important trend in healthcare:  evidence-based medicine.  It’s not long, and I urge you to read it.

The surprising truth is that the scientific practice of medicine is a very new development.  For centuries medicine was an apprenticeship in which traditional treatments were handed down from teacher to pupil without any objective investigation of either the mechanisms of disease or the effectiveness of treatment.  Even after the enlightenment and the spread of the scientific method, virtually no effective treatments had been developed for any illness.  Before the mid-nineteenth century, when Dr. Ignaz Semmelweis saved countless lives by insisting that doctors wash their hands before attending to women during childbirth, it is very unlikely that being treated by a physician for any condition did more good than harm.  (For those interested in history, a fascinating review of the history of medicine is in this Wikipedia article.)

The actual rigorous testing of treatments (whether they be medications, or surgeries, or psychotherapy) to see whether patients randomized to receive those treatments do better than patients randomized to receive placebo is embarrassingly recent.  Evidence-based medicine is simply educating doctors to look for such studies and to base their treatment of patients on the best scientific evidence available.  Evidence-based medicine began to be recommended in the 1990s!  As the TIME article details, it led to the realization that we were mistreating lots of diseases and lots of patients.  From treating irregular heartbeats in patients with heart attacks to estrogen replacement therapy after menopause, we were using medications that we thought should have been helping patients.  But we only found out we were hurting people after randomized trials were done.

The criticisms of evidence-based medicine in the article strike me as silly.  Practicing evidence-based medicine doesn’t mean I have to ignore my patients’ preferences or values.  It doesn’t mean I can’t be compassionate.  It doesn’t mean I have to prescribe the same thing for everybody.  Practicing evidence-based medicine just means that for some diseases, I know what works and what doesn’t.

(Thanks to my patient Mr. Milton Jupiter for pointing the TIME article to me.)