Evidence-Based Medicine
As Baron and Ejnes write, becoming certified by the ABIM or one of 21 subspecialties requires passing an examination. Physicians must pass exams throughout their career to maintain this certification, which helps ensure they are practicing evidence-based medicine supported by the latest, peer-reviewed research, with the goal of protecting patient well-being and safety. During the COVID-19 pandemic, aside from the vaccine scenario, hydroxychloroquine, which many of our patients rely on to manage their systemic lupus erythematosus and other rheumatic diseases, was in short supply. People were using hydroxychloroquine to treat COVID-19 despite a strong preponderance of evidence suggesting the drug did not have a benefit.
Let’s help avoid the perceived regression to a post-truth era in which people think, ‘I believe; therefore, I am right.’
Some issues can be more questionable when there is a disagreement about the interpretation of the facts. Those are not circumstances for which any of the oversight boards have a concern. We may agree to disagree, particularly as rheumatologists, when many elements are, in fact, uncertain; we are used to that in a specialty in which many things are incompletely understood about our diseases and our drugs. We understand that people may see things in different ways.
What we are really trying to avoid, particularly in rheumatology, is having people going back to snake oil. Let’s help avoid the perceived regression to a post-truth era in which people think, “I believe; therefore, I am right.” That’s antithetical to science. As the late Sen. Daniel Patrick Moynihan once said, “You are entitled to your opinion, but you are not entitled to your own facts.”
Climbing the Evidence Pyramid
A book by Adam Grant, Think Again, emphasizes that we want to avoid being preachers and politicians; we want to be scientists.3
We recognize that we are occasionally wrong. We often need to rethink things, and science is always questioning the evidence and recognizing that over time the evidence may change. This is reiterated by master clinician and rheumatologist Ron Anderson, MD, who notes, “Once you make a diagnosis, you stop thinking”; however, he admonishes: “Question your own diagnosis so that you never stop thinking, and remember that part of the differential diagnosis is that you are wrong.”4
To some degree, the facts can get modified as new evidence becomes available. We go as high in the evidence pyramid as we can, trying to promulgate what the science is successively showing us. This is the way most rheumatologists roll; we are uniquely poised to promulgate this approach in our patient care and in communicating how to understand scientific evidence to the general public.
