•As a medical student, I attended a lecture by breast surgeon Michael Baum. At that time, how breast cancer was treated depended largely on where the patient lived and on how hard she argued for the treatment which she believed to be right. Surgeons often rejected trials because they thought they knew best; so did the patients. There was no place for evidence-based medicine. But I have never forgotten what Baum said: “Every woman who is not in a controlled trial is in an uncontrolled trial.” Finally his trials established what treatments work better than others, and mutilation and death rates have decreased.
As an SHO I contributed to a DRCOG revision book. I tried to track the origins of the words of wisdom from Ten Teachers that were quoted to all students and repeated in all the other textbooks. I could find no evidence to support many of the ex cathedra statements which determined how young doctors were going to treat their patients.
Early converts to evidence-based medicine sometimes preached their message with an air of religiosity which irritated their colleagues. Now, when new treatments are presented we expect to see the research that supports them. So why is evidence-based medicine still so often regarded with suspicion?