The evidence base: rock of certainty or shifting sands?

I have a problem with evidence based medicine. This I know is a serious confession and could amount to professional misconduct, but in mitigation let me explain. The case I have is my own, so I will presume to tell you a little about myself.

After some years as a principal in general practice I joined the pharmaceutical industry. My medical history is unremarkable apart from two episodes of major depression, the first in my early thirties. For this I was given amitriptyline. The drug had no perceptible effect on the depression, but I became completely unable to concentrate, and my short term memory was seriously impaired. I had always done a lot of woodwork, but I found now that in the few seconds between taking a measurement and applying it to a piece of wood I had forgotten it.

My problem is not so much with evidence based medicine as with its users

However, the most disabling effect—one that I have never seen described—was a distancing from …