Sicily Evidence-Based Healthcare Conference 2023, reports by Hilda Bastian

From the second article this part caught my eye:
Is Critical Appraisal Training for Clinicians Doomed? (Sicily Conference Part 2)

Quote:
That opening lecture was by Gordon Guyatt – the GRADE pioneer, who also coined the phrase “evidence-based medicine” back in the early 1990s. It was just a small part of his talk, but he cited this essay he co-wrote with Kari Tikkinen that digs into it. He argued that teaching all clinicians how to essentially do a risk of bias assessment for a primary study (like a clinical trial) doesn’t work, because it’s not enough to achieve proficiency, and they don’t use it enough later on to affect their practice – or to solidify and extend the skills.

Meanwhile, Guyatt said, citing an international survey he, Tikkinen and others co-authored in 2016, even clinicians with some exposure to relevant education don’t understand outcome statistics from meta-analyses that are critical to well-informed evidence-based practice. Critical appraisal should be left to the experts, went the argument, and clinicians should be taught the skills they need to appreciate evidence basics and how to interpret and use evidence-based clinical practice guidelines and summaries of systematic reviews.

The leaving it to the experts part is what made me so uneasy, and I’ll come back to that....
end of quote

more at link where Hilda goes on to argue against Guyatt's view.
 
The first article:
A View From the Sicily Evidence-Based Healthcare Conference

The article focuses on discussions about living reviews and guidelines, particularly with reference to the pandemic. There were apparently strong disagreements on some aspects. Hilda expresses disagreement with John Ioannidis, I'm not clear what about.

A couple of quotes from the article:

The theme of the conference was the Ecosystem of Evidence, with a subtitle around Covid experiences and future challenges.
Click to expand...

BMJ editor Kamran Abbasi addressed the enormous level of conflict around evidence during the pandemic in his talk. He said the EBM community “needs to learn to debate as one tribe.” It’s an important point, and I’m still wondering about it. The definition of EBM is about using evidence, in combination with patients’ values and preferences. The pandemic revealed some profound differences in values between many of us. If it is a tribe, it’s definitely not a monoculture.
Click to expand...
 
The third article
From the Lab to Evidence Reviews to Communication (Sicily Conference Part 3)
Starts with a short section about animal experiments and problems of evidence often not being useful for humans.

The rest of the article is about Cochrane.

Quotes
Jordi Pardo Pardo, interim chair of the Cochrane Collaboration’s board, spoke to us via video link from Canada
...
There’s a website for their re-structuring process, called Future Cochrane, and that slogan was the theme of Pardo’s talk. From March 2020, early in the pandemic, Cochrane’s central focus shifted to evidence synthesis for pandemic-related questions. Pardo said they now see that process as the proof-of-concept for Future Cochrane.
...
Instead of the editorial process, including peer review, happening at the level of a plethora of topic-specific review groups, “Future Cochrane” reviews will be edited centrally.
end of quotes, more at link.

The final part of the article is about the talk Hilda was invited to give:

Quote:
One of my past Cochrane lives was being the founding Coordinating Editor of its review group on communication evidence. And I spoke about that a bit in my plenary talk on the conference’s last day. The topic they gave me was “How to improve patients’ and consumers’ involvement in healthcare.” I couldn’t really give an evidence-based answer to that question, for the same reason I left the review group.
...
more at link.
 
Bastian said:
The topic they gave me was “How to improve patients’ and consumers’ involvement in healthcare.” I couldn’t really give an evidence-based answer to that question, for the same reason I left the review group.
Click to expand...
Well, Cochrane has certainly provided a textbook example of how not to do that. Do the exact opposite of what they have been doing relating to us, and that's as strong a foundation as you can get. Other than just shutting down in disgrace and admitting this was all a giant mistake.

But the tribe and conflict bit is really telling of how thoroughly bankrupt the very idea of evidence-based medicine is. This is how it always went, it's how the philosophy of knowledge has always worked until a definitive proof shuts down debate. EBM is all debate, it's about staking a position and pushing it, evidence be damned. Hell, it's even mainly about fabricating evidence.

This is the old model that always prevails until definitive irrefutable evidence, in the form of reproducible lab experiments or math, ends all the silly posturing. And even when definitive proof is provided, a dysfunctional knowledge system will find ways to screw it all up, e.g. how long it took for medicine to acknowledge the germ theory of disease, and how they still don't even fully acknowledge it with their stubborn ideological denial of chronic illness.

Science is about making predictive knowledge. If you can't predict the outcome of doing something, then that knowledge is mostly useless, and can be very dangerous, is mostly political. Nothing in EBM can be predictive. Not a single thing. It routinely takes correlations and argues them to be causative in a preferred way, even when that preferred way is completely contradicted by reality, by evidence and by simple common sense. And it even refuses to apply basic knowledge from serious science, e.g. masks being based on reproducible physics and engineering.

The future of Cochrane is to shut down and serve as a warning about how not do things, and mark the end of the EBM era of failure. Science is the only valid system of knowledge, and only the scientific method, with falsification as its core, matters in the end. Everything else is just politics, self-interest, or both. And in EBM, it's the self-interest of institutions, clinicians and researchers that matters, the self-interest of patients is completely ignored, making it even worse than no system at all.

At best EBM can be described as a philosophical model, but being mostly ideological and riddled with bias and conflicts of interest, it's an especially bad one at that, since it doesn't care one bit about explicitly using logical fallacies and using them as evidence. It amounts to bad politics, bad philosophy, and peak pseudoscience. It will never amount to anything.
 
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