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Intellectuals have a choice to make…: they can either become demagogues and treat ideas as “swords against enemies,” or they can be teachers and use ideas as “plowshares to loosen the soil of contemplative thought.” - Max Weber (in Science as Vocation, 1946)
The appellation “evidence-based” is fast becoming de rigueur in any discussion on mental health care. Judging from the variety of uses to which it is put, however, one could be excused for mistaking it as simply a way to win an argument by intimidation (“I have read the evidence, which you clearly have not!”). I was attracted to the evidence-based medicine (EBM) approach as a medical student because of the explicit and transparent approach it offered toward clinical ignorance (my own) and uncertainty (in the available knowledge base) and the relief it offered in being able to tell the 2 apart! Since then I have turned to this approach often in my practice of clinical psychiatry, both as a way to make decisions in the face of considerable uncertainty and as a framework to teach about how to use population data for individual patient care. In this …