Interesting that Gavin Yamey's last word, and next to last word, on evidence-based medicine (EMB) involve anecdotes. In order to convince, he needs emotion and a story. It also seems that terms such as "hegemony" are too high fallotin' for him. Rather than deal with the substance of Holmes' paper, he is content to ridicule the language from a clubby, anti-intellectual, know-nothing perspective. ("I guess I am a microfascist" he joshes. Well.....)

I don't know the personal background of Gavin Yamey. I don't know whether he is a hero, as is Archie Cochrane, whether he personally suffered for freedom, or not. But when it comes to this argument, such moral history seems not very compelling. It is rather like giving Chairman Mao a pass because he DID go on that long march. Since this was for freedom, so is everything else that followed. Of course, I would never compare Archie Cochran to Mao or anyone else. I suppose if you know the man you have a right to defend him personally. It is obvious, however, that all sorts of bad ideas and practices spring from heroic and wonderful intentions.

Yamey sites Sackett's describing "evidence-based medicine" in his original article as "compassionate" etc. and we are to conclude that therefore it is. The tone of this Blog is not at all "microfascistic" but it certainly is Orwellian. I would say the same about EBM, despite the compassionate language of supporters such as Sackett (or precisely on account of such language.)

I will add that there are other approaches to science and to evidence that do not require a return to the bad old past. We are cut off these by EBM in precisely the manner that Holmes accurately describes, albeit in a post-modern idiom. I refer, for starters, to a article I wrote on this topic long ago for "Perspectives in Biology and Medicine" -- the central arguments are as relevant as ever -- available in two parts on the web at part one and part two) Jargon is always a problem, and I would agree that a more judicious use of language might have strengthened Holmes argument, made it appeal to a larger audience, or a least immunized it to a degree against the sort of classic ad-hominem attack mounted by Yamey. But sometimes new terms are useful. Some, such as "evidence-based-medicine" might be catchier than others -- not necessarily a benefit, and certainly one of the problems Orwell was getting at.