“You know, what if they were to actually put it’s [AI] mind to a science of practical compassion for everybody?… if the right machines were to come along and help us do it, that's going to be a fabulous thing.”
— Dr. Richard Lehman
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Dr Richard Lehman is a retired GP from Oxfordshire who had a "ringside seat" to the birth of evidence-based medicine, previously he held academic positions at Oxford and Yale, later becoming Professor of Shared Understanding of Medicine at the University of Birmingham. Dr Raj Mehta is a physician and evidence-based medicine educator who views EBM as essential heuristics for discerning truth in clinical practice. Together, they bring decades of experience wrestling with how we know what works in medicine, from the historical foundations laid by James Lind's scurvy trials to the AI revolution that promises to transform how we synthesise and apply medical evidence.
Key Takeaways
Truth-seeking requires method, not just conviction: Before EBM, medicine operated largely on "conviction-based" approaches collected in massive textbooks. The shift to systematic evidence evaluation transformed how we separate opinion from fact in clinical practice.
Numbers Needed to Treat illuminate magnitude: Tools like NNT help clinicians and patients understand effect sizes. Context and timeframe matter enormously.
AI could democratise and personalise evidence: Rather than replacing doctors, AI might enable real-time synthesis of evidence matched to individual patients, creating feedback loops between treatments and outcomes at an unprecedented scale.
The evidence map has gaps and mountains: Current evidence is like an 18th-century road atlas - some areas well-mapped, others blank. AI could be the "sat nav system" for medicine that acknowledges uncertainty while guiding decisions.
Social determinants still trump beta blockers: While we refine molecular treatments, the biggest health impacts remain at the policy level - safe neighbourhoods, warm homes, and social conditions. Medicine must embrace "practical compassion" beyond prescriptions.
Where to Find Our Guests
In This Episode
00:00 - Introduction: Why evidence-based medicine matters now more than ever
02:54 - The scientific method in medicine: Discerning truth from fiction in clinical practice
06:06 - James Lind and scurvy: The 200-year gap between discovery and adoption
12:01 - Bradford Hill and the RCT revolution: Moving from mechanism to measurement
14:29 - Richard's ringside view: When "evidence-based medicine" arrived in Oxford
19:10 - The limits of population evidence: Why Numbers Needed to Treat aren't enough
22:39 - Shared decision-making complexity: The overwhelming challenge of multimorbidity
26:00 - The AI revolution: From medical scribes to comprehensive evidence synthesis
29:39 - Patient empowerment in the age of monetised medicine
36:43 - The pre-Copernican challenge: Are we just getting better at measuring the wrong thing?
39:01 - China as a sandbox: Where innovation might overtake Silicon Valley
44:54 - Beyond beta blockers: Why social determinants still matter most
54:10 - COVID-19's mixed report card: EBM's triumphs and failures in crisis
59:04 - Communicating uncertainty: The topographical map of medical evidence
1:01:39 - Looking forward: Why this is a "fabulous time in medicine"
Referenced
Contact
If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com
Music Attribution: Music by AudioCoffee from Pixabay.
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