BMJ  2005;330:E340 (19 March), doi:10.1136/bmj.330.7492.E340

BMJ USA: Editor's choice

On experts

It turns out that the word expert comes from the same root as the words experience and experiment, two very different concepts. All three derive from a Latin word defined variously as meaning try or test. Pairing the words—experience and try, experiment and test—nicely captures the current controversy about experts.

On the one hand, experts are people with experience in a certain field who have tried many things and have formed opinions and habits based on what seems to work for them. When generalists consult such experts, it is reassuring to learn of their experience and to hear their wise advice about a problem.

On the other hand, experience alone is only one part of delivering good medical care. That is where the concepts of experiment and test come in. Unless the expert can also systematically incorporate appropriate experimental evidence into his or her recommendations, we are left only with selective experience, what some have called "eminence-based medicine." It may do more harm than good.

In this issue, Andrew Oxman and colleagues (p 82) portray the various types of medical experts as different species of birds, each with its own voice, plumage, and habits. This clever send-up is reprinted from the BMJ's light-hearted Christmas issue.

We then move from eminence-based medicine to evidence-based eating. Oscar Franco and others (p 71) give a tasty rebuttal to proposals to combine several drugs that are good for us into a single Polypill by concocting what they call a Polymeal. Composed of wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds, it is guaranteed (well, at least intended) to decrease cardiovascular disease by 75% in those who follow it.

Other evidence-based guidance in this issue includes a meta-analysis by Mahyar Etminan and associates (p 62) that suggests that migraine may be a risk factor in developing a stroke, and a trial by Paul Corwin and colleagues (p 78) documenting that home antibiotic treatment of cellulitis is safe and well-received in selected patients.

Lest you think we are slaves to evidence-based fashion, we have plenty of preaching experts too. Petrie and Wessely (p 56) decry our modern obsession with bottled water, and Peter Mansfield and others (p 57) attack direct-to-consumer advertising. But at least these pronouncements run in the section of the journal labeled "Editorials," giving the reader fair warning that unsupported opinions and selective citations may lurk within.

Caveat lector.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Rapid Responses:

Read all Rapid Responses

A Definition of Experience

Andrew D. Lynk
bmj.com, 23 Mar 2005 [Full text]

Malariatherapy for syphilis not "arrogant"

Jeffrey S. Sartin, et al.
bmj.com, 24 Mar 2005 [Full text]