A few months ago medical blogger Laika wrote an insightful blog entry summarizing a meme which had been bouncing around twitter regarding whether UpToDate was evidence based medicine or some other entity.
I found the whole excercise to be a bit too philosophical for me. Regardless of what you call it I think everyone would agree that UpToDate is useful. It is a great starting place but usually insufficient as a single source.
I was reminded about it today when I came across this paragraph:
In the card on “Clinical manifestations, diagnosis, and natural history of primary biliary cirrhosis.” (Link for subsribers)
Regardless of the merits of UpToDate, nothing breaks the illussion of evidence based medicine like an author throwing out a random statistic like “approximately 15% of the 1,200 patients who I have seen…” without a reference. This is the epitome of expert oriented experiential medicine and has no place in EBM.
a very intersting blog and discussion about uptodate and I am especially interested to hear more about areas of uptodate which are not evidence based on make random statements based on opinion. in the above case of primary biliary cirrhosis, it does sound like a rather sweeping statement to make by the author, but could it in fact be true as there are no really high quality evidence supporting the treatments for primary biliary cirrhosis ? if the evidence is bad, low quality or missing, then maybe expert opinion is the way to go ?
The point is there is published data on the very subject the author weighs in on (reference 32). The published data says 8% but the author gives unreferenced data showing a rate twice as high.
So when the urologist who did my vasectomy told me that there was a 17% chance of chronic pain reported in a study, but then said that if it were really 17% we wouldn't be doing them, he was wrong? The 1 study means more than his 15 years experience that had no where near 17% of patients with chronic pain? You should consider the resource, and who is interpreting the data.