David Eddy did nothing to reassure Kent Bottles about evidence-based guidelines in his recent keynote, saying essentially: “The problem is that we don’t know what we are doing” (!!)
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Dr. Eddy did say that quotation in the BusinessWeek article referenced in the original blog post. In the Reinertsen Lecture he did a masterful job of showing how today’s evidence-based guidelines are better than no guidelines at all. However, he did point out that today’s evidence-based guidelines do have limitations. For example, many patients have multiple diseases, the need for sharp cut-offs in guidelines do result in the need for clinical judgment, and the need for shared decision-making between patient and provider. Dr. Eddy did reassure me that computer-based simulation may be a way to move evidence-based medicine forward from today’s single disease guidelines. I would refer readers to the comment by Al Burgener in the original ICSI blog: we need Informed Judgment