Adv Chronic Kidney Dis. 2012 Jan;19(1):1-2. doi: 10.1053/j.ackd.2012.01.006.
Eminence-based medicine: the King is dead.
"Although possibly difficult to reconcile, many of us nephrologists were trained in our discipline by what some would refer to as “eminence-based medicine.” Our supervising physicians were emperors of the courts of medical knowledge and progress, often trained in basic science and with evident knowledge of the Bonferroni correction to preclude cumulative type 1 errors or alpha inflation.1 These kings could, when they deigned to, humble and stupefy us with their brilliance, solely steeped in the faith of the mechanistic world of biological plausibility, renal transport mechanisms, and pure, unconfounded, unadulterated experimentation. Because “they said so,” they were correct and our own hypotheses were cast aside, albeit as type 2 errors! Often and years later, we have come to realize that the evidence for their decrees were simply their best estimates based on either small, uncontrolled, observational studies, sometimes “N” equaling “1,” or simply a dearth of information. No lie was intended, just an eliding of the facts whenever they existed.
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Therefore, we must educate and enrich our charges, our colleagues, and most importantly, ourselves, in evidence-based medicine, not eminence-based medicine. Such education will only provide for patients in a more meaningful way, prevent waste, and reduce the overall cost of health care. This form of education does not supersede or better others such as the basic sciences, but like them, it is necessary and not sufficient. Evidence-based medicine teaching must be plied early on and considered a fundamental competency in the same manner that the physical examination was and still is. A true embracing of this proposal is challenging and requires a fundamental shift in medical education. As a case in point, the Canadian medical school system zealously adopted and implemented this attitude years ago."
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