Members of the public
Beware reliance on 'experience' with no reference to relevant evidence.
Key Concepts addressed:
I’ve heard versions of this “increasing confidence” aphorism for years, but recently wondered it came from. This seems to be its source –
A Skeptic’s Medical Dictionary, by Michael O’Donnell:
Clinical experience. Making the same mistakes with increasing confidence over an impressive number of years.
Evidence-based medicine. Perpetuating other people’s mistakes instead of your own.
– and see the book review in The Lancet .) The BMJ
pointed out that Oscar Wilde said something similar – and it is as exquisite as you would expect. It’s here, in his 1890 : The Picture of Dorian Gray
He began to wonder whether we could ever make psychology so absolute a science that each little spring of life would be revealed to us. As it was, we always misunderstood ourselves and rarely understood others. Experience was of no ethical value. It was merely the name men gave to their mistakes. Moralists had, as a rule, regarded it as a mode of warning, had claimed for it a certain ethical efficacy in the formation of character, had praised it as something that taught us what to follow and showed us what to avoid. But there was no motive power in experience. It was as little of an active cause as conscience itself. All that it really demonstrated was that our future would be the same as our past, and that the sin we had done once, and with loathing, we would do many times, and with joy.
It was clear to him that the experimental method was the only method by which one could arrive at any scientific analysis of the passions; and certainly Dorian Gray was a subject made to his hand, and seemed to promise rich and fruitful results.
From the sublime to the ridiculous. I’ve another to add to this picture. It’s based on an aphorism I coined myself in a piece I wrote in
– cartoon version and post The BMJ in 2004 here on Statistically Funny.
Promising treatment. The larval stage of a disappointing one.
Calling treatments “promising” is a problem that seems to afflict all sides – including evidence-based medicine (EBM). As I’m lampooning the worst side of clinical experience with this cartoon though, it seems only fair for balance to have a shot at EBM at the same time. Here’s where I’ve written about problems in EBM this year at
MedPage Today and PLOS Blogs.
The most important article recently on this subject, though, is from Trisha Greenhalgh and colleagues:
Six ‘biases’ against patients and carers in evidence-based medicine.
Cartoons are available for use, with credit to Hilda Bastian.
Browse Key Concepts
Back to Library
Select a term acceptability
allocation schedule concealment
certainty of the evidence
change in cost
cluster randomized study
comparing like with like
conflicts of interests
controlled before-after study
diagnostic odds ratio
diagnostic test accuracy
disease progression bias
dramatic treatment effect
evidence to decision framework
fair comparisons of treatments
false negative test result
false negative test result (duplicate)
false positive test result
false positive test result (duplicate)
high certainty of the evidence
incremental cost-effectiveness ratio
indeterminate diagnostic test result
interrupted time series study
level of evidence
loss to follow-up
low certainty of the evidence
low risk of bias
margin of error
moderate certainty of the evidence
modified intention-to-treat analysis
multiple statistical comparisons
natural course of health problems
negative predictive value
number needed to harm
number needed to screen
number needed to treat
outcome measured on a scale
paired study design for diagnostic tests
parallel group study
phase 1 trial
phase 2 trial
phase 3 trial
phase 4 trial
play of chance
positive predictive value
protocol or study plan
quality-adjusted life years
reference standard test
regulation of research
repeated measures study
risk of bias
shared decision making
single participant trial
smallest important difference
strength of recommendation
summary of findings
treatment comparison group
true negative test result
true positive test result
type of study
unit of analysis error
very low certainty of the evidence
GET-IT provides plain language definitions of health research terms