Emotions Over Evidence

I believe in following the evidence as much as possible when practicing medicine. “We” have decided in this country that teaching EBM skills is important and these concepts are part of every medical school’s curriculum. Why don’t we teach evidence-based living? So much of what we do and believe in is emotionally based. There is lots of evidence around us but our emotions make us ignore it. The gun control debate we are having in this country really underscores this. There are no randomized controlled trials of gun control. There never will be. What we have are observational studies. Like all evidence it is filtered through each individual’s prism and gets bent in a variety of directions.

There is no convincing either side of the gun debate. I like guns. I have several guns. My emotions tell me they are not the problem (None of my guns has ever attacked me. Thus my belief that guns dont kill). I BELIEVE there is evidence supporting my point of view. But so does the gun control community. Just like in many facets of medicine there is a limited body of evidence that both sides (pro-gun vs anti-gun) look at differently because of their emotional investment in the subject. When you have a tragedy like Connecticut emotions further overwhelm the evidence. There were many laws broken that day. More laws wouldn’t have prevented that tragedy and won’t prevent a tragedy like that in the future. Why can’t they see this evidence?

When a women is diagnosed with early stage  breast cancer because of a screening mammogram she believes it saved her life. So too will her doctor. There is an emotional attachment to the interpretation of this event. But what about the evidence? Most breast cancer detected by screening will never hurt you (N Engl J Med 2012;  367:1998-2005). But try to recommend against mammographic screening and emotions take over. Evidence be damned!

It’s very difficult to disconnect your emotions from evidence. Especially if that evidence goes against what you have been taught….what you see in your limited world….what you believe! I guess my point of this rant is to recognize that you have to take a dispassionate look at evidence…in all aspects of life. The only filter it should go through is the validity filter- is the evidence likely unbiased. Leave your beliefs and emotions out if it. You might be surprised by what you see.