Are Evidence-Based Medicine and Public Health Incompatible?

Essay by Michael Schulson: “It’s a familiar pandemic story: In September 2020, Angela McLean and John Edmunds found themselves sitting in the same Zoom meeting, listening to a discussion they didn’t like.

At some point during the meeting, McLean — professor of mathematical biology at the Oxford University, dame commander of the Order of the British Empire, fellow of the Royal Society of London, and then-chief scientific adviser to the United Kingdom’s Ministry of Defense — sent Edmunds a message on WhatsApp.

“Who is this fuckwitt?” she asked.

The message was evidently referring to Carl Heneghan, director of the Center for Evidence-Based Medicine at Oxford. He was on Zoom that day, along with McLean and Edmunds and two other experts, to advise the British prime minister on the Covid-19 pandemic.

Their disagreement — recently made public as part of a British government inquiry into the Covid-19 response — is one small chapter in a long-running clash between two schools of thought within the world of health care.

McLean and Edmunds are experts in infectious disease modeling; they build elaborate simulations of pandemics, which they use to predict how infections will spread and how best to slow them down. Often, during the Covid-19 pandemic, such models were used alongside other forms of evidence to urge more restrictions to slow the spread of the disease. Heneghan, meanwhile, is a prominent figure in the world of evidence-based medicine, or EBM. The movement aims to help doctors draw on the best available evidence when making decisions and advising patients. Over the past 30 years, EBM has transformed the practice of medicine worldwide.

Whether it can transform the practice of public health — which focuses not on individuals, but on keeping the broader community healthy — is a thornier question…(More)”.

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