I've been doing science for my entire career. It's not a popular view, but what I've seen of the medical profession does not engender in me the same kind of trust that I have for other sciences.

Based on knowledge acquired and refined repeatedly and relentlessly, I trust the materials scientist. I trust that a simulation set up to test the vibration of a fighter jet at Mach 3 will give back reliable, repeatable results.

I trust that gravity will take the remote out of my hand and throw it to the floor. I trust that a laser will lase, that a computer will compute, and that my anti-lock braking system will stop my car before it crashes.

I trust that the avionics in the 737 I took from Detroit to Atlanta will get it there with a probability of well in excess of 99.9999% (1 in a million). (In fact, six 9's is a wholly unacceptable safety rate for commercial aircraft.)

Doctors, on the other hand, scare me. True, the root cause of the lack of surety is that living systems are vastly complex and that experimenting with life and death is not acceptable. However, this does not mean that experience and a confident, sage demeanor give me anything like the trust I have in a flying tube of aluminum.

In my view, evidence based medicine is a baby step toward the same mechanistic toward the ideal of understanding living organisms that the paper derides.

Medicine should be science. It should be engineering. What a doctor does to a patient should be viewed as maintenance and repair, not a treatment or values. As it is, there is far too much guesswork and loose probabilities and "let's try this to see how it works out". We should know with high confidence how it will work out.

The thing is, we are already creating stable systems across many fields that approach the complexity of biology and they work. While our knowledge of how we work is incomplete, all mysteries will of course be penetrated, it's only a matter of when.

Let's make it sooner rather than later. A concerted, systematic effort to understand everything about ourselves can only succeed in the same way a concerted, systematic effort produced a nuclear bomb or a space shuttle.

Momentum holds us back. I don't want explanations why my L5S1 disk disintegrated or councelling or pain relief; I want it repaired, and if the design is lacking, I want it corrected and refitted. I want the control to have it done the way I choose, and I want the power to diagnose it myself with readily available sensors and tools.

It's not well and good to engage in any activity that holds back our understanding in any way.

If I understand the arguments of the paper, the principle worry regarding EBT is that the regimented and structured approach takes away choices from the caregiver/patient, which really means "takes choices from the caregiver", because the patient is usually fed information to lead them to the choices the caregiver wants him to make.

Another principle worry seems to be that procedures and best practices developed will not undergo the type of refinement that corrects most scientific models, but instead mechanize the doctors. This doesn't mean that the approach should be scrapped or backed away from, it means that it should be refined -- each application of a best practice should be recorded in every detail for feedback into the system.

In any case, we shouldn't be led down the path away from ideal of complete understanding in the name of traditional relationships.

The paper under examination here is an example of exactly the wrong way to go. It argues using philosophy, such as "what is evidence?" (Science answered this question centuries ago). It argues uncertainty and ignorance, "what does the woman with 40% chance of developing breast cancer do." (A model that predicts an outcome with 40% probability is a completely unacceptable.) It argues emotion and comfort. It argues organization and authority.

What it should be doing is presenting results and scientific models (with real math and physics and chemistry in them). It should point out weaknesses in existing models and propose new ones.

That's what science is, not arguing with sophistry and politics from a basis of an emotional reaction to perceived loss of freedom.