Eminence vs Evidence

I was recently listening to a Podcast called Freakanomics Radio (check it out! Gets da brain working) and the topic of medicine was brought up. Naturally this peaked my interest, the topic was called Bad Medicine, it went over the fallacy of the “average” temperature 98.6, drug trials, insurance and what most caught my ear, the idea of eminence based medicine.

Eminence based medicine is “medical practice driven by really charismatic and thoughtful, probably, to some degree, leaders in medicine.” (Prassad) Unfortunately eminence can lead to some deadly errors in our thought processes. The recent proven safe usage of tourniquets come to mind. Once the boogeyman of prehospital medicine, we’ve come to agree that tourniquets are an effective device that can be placed without fear of limb loss (barring additional injuries or prolonged placement). Why for the entire history of medicine did it take so long to accept tourniquet use? How did the idea that massive hemorrhage control actually does take precedence over airway finally come to light? The answer is evidence. It took small committees in SOCOM and the DOD to look hard and fast at our numbers, at the data to determine what works and what doesn’t. That the tourniquet is in fact a viable life saving device. “Duh” you say, but truthfully it wasn’t that long ago that you’d have a Senior Medic/ Corpsman yelling and screaming against the idea. Those Senior Medics and Corpsmen were wrong, it’s easy to look back and say that. I was once told that tampons are great for bullet wounds (they aren’t). Knowledge, whether true or false, is propagated in our industry by our seniors, our trainers and even our Doctors. Remember, Doctors use to blood let, give out cocaine, and prescribe mercury…

So what’s the point of all of this? Medicine is a science (many say it’s an art), but up until very recently it was “based on bits and scraps of evidence, anecdotes, bias, preconceived notions, and probably a lot of psychological traps we fall into.” (Prassad) Allow the recent use of clinical trials, and evidence to assist you. I want you take a long hard look at your kit, your devices, how you do things and ask, is this best for me? For my patient? Ask yourself and your peers why! Read studies on the latest and greatest. If there aren’t any studies, then ask for them to be conducted before you trust your patients to them. Don’t just do something because you were told to. Understand the reasoning, the science, and the application of what you’re doing. If you think something is great because you saw it on the internet then you’re not learning from the past. Ensure the items you use have the backing, testing and trials done before it becomes part of your every day carry. Eminence can be a great way to get info out there, but it needs to have evidence supporting it lest we start using crystals and incense to heal our patients.


Prassad, V. (Professor of Medicine at Oregon Health and Science University). Freaknomics Radio: Bad Medicine Part 1. Retrieved from http:freakanomics.com/podcast/bad-medicine-part-1-story-98-6/.