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"Evidence-Based Medicine" Compared with Prussian "Enlightened Absolutism" in Journal of American Physicians and Surgeons Tucson, Arizona
"Evidence-based medicine" has been elevated to the status of an obligatory "gold standard" of medical care. Physicians who deviate from the EBM "standard of care" are likely to be marginalized and face malpractice liability or even the ruin of their careers. In the fall issue of the Journal of American Physicians and Surgeons, Hermann W. Borg, M.D., draws some historic parallels to medicine in Prussia at the time of the Enlightenment.
"There are striking similarities between the culture of the early Enlightenment and today's post-modern digital revolution," he writes. There was rapid change, with empowerment of new groups, as knowledge became more widely available. This threatened the existing power structure. Outright suppression by force backfired. So the political aristocracy outwardly seemed to embrace the new ideas while covertly sabotaging and subverting them.
The Prussian model shows most clearly the effects of injecting political power into medical practice, Borg explains. The Prussian system conferred the title Geheim Rath (secret or confidential counsel) on persons of recognized professional achievement, who had great influence both inside and outside academia. "The main stated objectives were to improve the quality, effectiveness, and affordability of medical care throughout the kingdom," Borg writes, just like today. "This was supposed to be done by elimination of 'nonscientific' treatment methods through leveraging the expertise of accomplished physicians."
The guiding principle of EBM is also the old Prussian principle of "one elegant formula can solve all the problems," Borg states. Enlightenment theorists could not understand why medicine did not achieve spectacular advances like those in industry and agriculture. "Perhaps the idea that treating patients cannot be compared to making machines or farming did not occur to them," he suggests.
Instead of improving medical care, the Geheim Rath system caused chaos, fostered corruption and exploitation of young physicians, and promptly became fossilized and interfered with any innovations, especially those contradicting government dogma, he states.
Despite its claims to be totally "objective," EBM generates guidelines through consensus of chosen experts, each of whom has subjective biases. But consensus is the basis of politics, not science, Borg points out.
The two outwardly different schemes have many common denominators, he notes. In both the Geheim Rath system and EBM, the decision-making process is being out-sourced. It is removed from the individual patient-physician interaction.
The results for medicine are likely to be similar, he concludes.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.