“Grains of Truth” vs Evidence-Based Medicine”

For the layman, “old wifes’ tales” (“a wisdom much like an urban legend, supposedly passed down by old wives to a younger generation. It is so named for the alleged lack of sophistication of old wives.”) often deal with sex, pregnancy, puberty, nutrition and health issues. Most of the tales have no basis in fact but occasionally a few have, as quoted from the Wikipedia article, “... grains of truth, the veracity is likely coincidental.”

In medicine, physicians have carried along the professional version of “old wives’ tales” through the years, the veracity of which was mainly based on a physician’s own personal experiences in practice, the reports of other physicians experiences or just theories. Some of these tales dealt with issues of diagnosis or illness outcomes and others dealt with therapeutic benefit of drugs or procedures.

In the last decade or so, out of concern for providing the best in medical care but also because of concerns relating to the financing of medical care that the medical profession and others have looked to providing physicians and their patients the results of “evidence-based medicine” which defined by the Centre for Evidence Based Medicine as quoted in the Wikipedia article “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." And continuing from the Wikipedia article “Using techniques from science, engineering and statistics, such as meta-analysis of scientific literature, risk-benefit analysis, and randomized controlled trials, it aims for the ideal that healthcare professionals should make ‘conscientious, explicit, and judicious use of current best evidence’ in their everyday practice.”


What has all of this to do with medical ethics? It has to do with the physician’s duty to be trustworthy to the patient and to aim to do good and not produce harm to the patient. Informing the patient, unless some patient rejects being informed, is also duty of the physician and is part of the consent to treatment process. It should be a standard of medical practice that the patient understand what portions of the physician’s decisions regarding diagnosis, prognosis or treatment is based on reliable evidence and which is based on hearsay or simply statistically not verified experience. But do most physicians have the time or skill to explain to the patient on what basis their decisions were made? Further, do most physicians even know which of the “facts” they are using have not been rigorously proven? Unfortunately, even with the best of physician attention to educate themselves on the evidence and to explain this to the patients, there is much in medical care that will remain “old tales” either because there is not sufficient interest to provide the time and expense to do scientific studies or realistically because some studies just can’t be accomplished because of technical or ethical issues. Fortunately,for both the patient and the physician, many decisions the physician makes do have incidentally those “grains of truth” and are luckily followed by successful outcomes. ..Maurice.