BMJ  2003;327:E63 (4 October), doi:10.1136/bmjusa.01090006 (published 5 September 2002)

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

Webidence-based medicine

This article originally appeared in BMJ USA

Editor—Isaacs and Fitzgerald provide an excellent review of alternative practice justification methods. May I suggest yet another method of persuasion practiced by the medical digiterati? Webidence is scientific (type 1) and pseudo-scientific (type 2) medical advice and opinion posted on a web site. The marker for this is "sticky eyeballs," the measuring device is the web hit counter, and the unit is the unique hit and repeat visit count. Unfortunately no reputable authority exists for separating type 1 and 2. Perhaps a market niche?

George Washington University, Washington, DC, USA hcsbxs{at}gwumc.edu

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Profit-based medicine (aka opulence-based medicine)

Editor—One alternative, which may be especially prevalent in private practice and fee-for-service remuneration systems, is profit-based medicine (also known as opulence-based medicine): the conscientious, explicit, and judicious use of the most profitable and lucrative interventions when making decisions about the care of individual patients.

Unit for Cybermedicine, Department of Clinical Social Medicine, University of Heidelberg, Heidelberg, Germany ey{at}yi.com

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Annoyance-based medicine

Editor—An additional category might be called "annoyance-based medicine" or "avoidance-based medicine." This occurs when a patient or family, or other practitioners, become so annoying in their demands for a specific course of care that the physician gives in. Examples include the mother who demands antibiotics for her child's colds; the patient who demands unnecessary diagnostic tests incessantly until the physician orders them; and the internist who is convinced that the patient's problem is due to gallbladder disease, and who refers the patient to a surgeon repeatedly until he/she gives in and does a cholecystectomy (usually not relieving the patient's symptoms).

Cooper Health System, Camden, New Jersey, USA rosssemd{at}hotmail.com

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Propaganda-based medicine

Editor—Isaacs and Fitzgerald neglect a commonly used eighth alternative: "propaganda-based medicine." If a physician only has a limited amount of time for scientific training, if he swallows anything he is told, or if he finds himself in any other unmentionable circumstance, he may fall prey to the pharmaceutical representatives who possess the best strategies for changing physician behavior.

There are two types of propaganda-based medicine: A and B. The markers are: type A—gullibility level; and type B—unexplainable variation in the prescribing of pharmaceuticals. The measuring devices are: type A—reactions to a test such as being told that you have a 40 000-legged spider on your back; and type B—a piggy bank. The units of measurement are: type A—rate of frightened responses to the spider test; and type B—$.

Unit for Technology Assessment and Quality Assurance, Padova, Italy farmosp16{at}pd.nettuno.it

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Arrogance-based medicine

Editor—I wish to add "arrogance-based medicine" to the list. This is particularly relevant in teaching hospitals where opinions are given out as fact, and no explanations are needed. The measuring device is phrase count. The unit of measurement is the phrase "because I said so." Admittedly, this category overlaps with eminence-based medicine and eloquence-based medicine.

University of Washington, Harborview Medical Center, Seattle, Washington, USA artlam{at}u.washington.edu

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Women and medical eminence

Editor—Having some doubts about the religious zeal surrounding evidence-based medicine, I greatly enjoyed "Seven alternatives to evidence based medicine." However, I was dismayed to see that until women begin to suffer from balding, we cannot achieve the "halo" effect, presumably reserved for those most eminent.

Department of Epidemiology and Preventive Medicine Monash University, Victoria, Australia Bebe.Loff{at}Med.monash.edu.au

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Competing interests: None other than female status.

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