How to Base Medicine on Evidence

The thing to notice about what the New York Times calls “the evidence-based medicine practiced at Intermountain hospital” is how different it is than the movement called evidence-based medicine. The Intermountain stuff, above all, is not black-and-white thinking. It is a good example of what the opposite looks like. The rules aren’t simple, they are complex, and not fixed. It is what engineers in other areas have been doing since Deming.

So many scientists — not to mention everyone else — are completely paralyzed, rendered completely useless, by their black-and-white thinking. It feels good to them — they love the certainty of it, and the power it gives them to look down on others — and they never quite realize what it has done to them. The notion of using evidence to improve health care made perfect sense — until black-and-white thinkers got a hold of it.

Any class in scientific method should be at least half about avoiding black-and-white thinking. They never are.