GRADEpro is the software of choice for experts who care about the highest quality of evidence and the most reliable sources in medical science. Of course a lot of ‘scientists’ still prefer some alternative approaches. As summer vacation begins for many of us, let us recall the clever recap “Seven alternatives to evidence based medicine” by David Isaacs and Dominic Fitzgerald in BMJ. This witty article was written almost decade ago, but we find its relevance very much alive today:
(1) Eminence based medicine – when doctors have a touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence over an impressive number of years.”
(2) Vehemence based medicine – The substitution of volume for evidence is an effective technique for brow beating your more timorous colleagues and for convincing relatives of your ability.
(3) Eloquence based medicine – Sartorial elegance and verbal eloquence are powerful substitutes for evidence.
(4) Providence based medicine – If the caring practitioner has no idea of what to do next, the decision may be best left in the hands of the Almighty.
(5) Diffidence based medicine – Some doctors see a problem and look for an answer. Others merely see a problem. The diffident doctor may do nothing from a sense of despair.
(6) Nervousness based medicine – Fear of litigation is a powerful stimulus to overinvestigation and overtreatment.
(7) Confidence based medicine – restricted to surgeons. In the table there are more details: marker – bravado, measuring device – sweat test, unit of measurement – no sweat.
This bright classification was supplemented by Aldo Mariotto with the term:
(8) Propaganda based medicine, that is connected with pharmaceutical representatives’ influence on physicians.
… we can’t find any culminating point, just use GRADEing!