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Overcoming Bias Commenter's avatar

Robin, IMO that tension will always be there, more in some cases than others. No matter how good the evidence, the question of external validity will always be present. Is this patient sufficiently unique that they are in the tail of the distribution? The relative costs of the two errors are very different - I prescribe the more expensive drug because when it is of no additional benefit to the patient vs. I don't and it would have been. The Vioxx case illustrates the rare subclass problem; I may believe, rightly or wrongly, that there are subtle differences between the drugs that are very difficult to detect from a statistical power perspective. Thus, I am justified in using the more expensive one.

IMO, the most interesting question is what would be positive motivations for physicians to adopt EBM? I suspect that more information within the professional curriculum on the weaknesses of human reasoning, the effects of cognitive biases and how to overcome these might. AFAIK, little or none of this information is presented now. In other words, would understanding the presence of these in a metacognitive way improve one's reasoning and improve the adoption of EBM. Although many physicians would claim that the practice of medicine is based on science and many have undergraduate degrees in science areas, I suspect that most such degrees do not provide a solid understanding the fundamentals of the scientific method or understand the history of science, both of which illustrate why science is currently done the way it is. IMO, good philosophy of science and history of science courses should be core requirements for such undergraduate degrees and for medicine.

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Robin Hanson's avatar

JMG3Y, yes, if doctors in fact followed a good form of evidence-based medicine, there would of course be less concern about their possible biases. The question I highlighted in my post is the tension between the evidence we do have and individual doctor judgments which may conflict in some cases.

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