Letters to the Editor
I have great difficulty in buying Henry and colleagues' comparison of evidence-based medicine (EBM) as practiced in the late 20th century to the field of logical positivism that predates EBM some 100 years, as they argue in their letter. Believe it or not, the claims of EBM practitioners are far more humble than those of the logical positivists. The founders of EBM never thought they would explain everything in the medical encounter. Despite using phrases such as “Medicine needs a more robust epistemology [than EBM]” and “the need to move beyond EBM,” if Henry and his coauthors agree not to throw the baby out with the bathwater, then I am in agreement, while acknowledging that EBM is here to stay for some very good reasons. Calling the term EBM “tendentious” hardly advances any argument. Although I passionately agree with them about the need to develop a person-centered model, I do not think “moving beyond EBM” and embracing Michael Polanyi's tacit knowing would accomplish what they claim. EBM is not the cause of what is wrong in medicine or the world.
In addition, as presented in both our articles and stated by many others, we need a whole new area of scholarship that better elucidates what person-centered care is and how we get there from here. From my many motorcycle trips, I have learned that there are lots of routes to the same destination. However, some routes will never get you to where you want to go. Taking the exit marked Michael Polanyi will get you to a lot of interesting places, but I do not believe it will get you to the practice of person-centered care. However, if Henry and his colleagues get there through this route, I will be more than happy to follow them next time around. The tragedy is that almost no one knows about Michael Polanyi and his great insights, which could be of great value to the entire spectrum of medical education, practice, and research.1 Humanizing the medical encounter, however, would not be one of those expected benefits.
David Gary Smith, MD
Director of graduate medical education, Abington
Memorial Hospital, Abington, Pennsylvania, and clinical associate professor of medicine, Temple
University School of Medicine, Philadelphia,
1 Scott W, Moleski M. Michael Polanyi: Scientist and Philosopher. New York, NY: Oxford University Press; 2005.