Like so many things in life this is far from black and white and the point made here is far from a joke.
While the number of randomised clinical trials grew from fewer than 500 per year in 1970 to 15,000 in 2006, still less than 0.1% of patients are enrolled in these formal clinical studies. Those enrolled are not likely to be representative of the larger patient population, so those in medicine cannot honestly say that they learn much about the effects of a procedural, clinical, or pharmaceutical intervention for the remaining 99.9%. Sidney Dekker (2011) Patient Safety.
Meaning: phenomenology and the personal experience of both clinicians and the patients plays a far more significant role in the everyday practice of medicine than evidence gathered in randomised trials ever can in the foreseeable future. We have to recognise that medicine will never achieve the levels of evidence accepted and expected in aviation where 99.9% of flight data is monitored and therefore 99.9% data is available for analysis compared with the 0.1% in medicine. And mysteries still remain
For those of us working in medicine, trying to improve the safety and quality of care, the current battle is to a large extent about re-allowing for common sense i.e. evidence gained by experience into the clinical setting. The trend is to dismiss human judgement (is it or is it not safe to jump?) and justify every decision by often dubious "evidence."
Yes, there is a desperate need to create space and time for reflective practice to counter balance the many psychological biases which creep into professional practice and skew judgement but let's not kid ourselves evidence from randomised trials can only be relevant on the margins of medicine.
Maggie, please, re-read this article knowing that those making funding decisions in health care do believe that
"It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial." (page 1459)
And nowhere more so than when it comes to women's bodies i.e. obstetrics!