Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
EditorialCommentary

Stop invoking evidence-based data!

Roger Ladouceur
Canadian Family Physician April 2018; 64 (4) 246;
Roger Ladouceur
MD MSc CCMF(SP) FCMF
Roles: ASSOCIATE SCIENTIFIC EDITOR
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading
Figure

A few years ago, Family Medicine Forum introduced its annual Dangerous Ideas Soapbox. This event

offers a platform for you as an innovator to share an important idea that is not being heard but needs to be heard in the family medicine community. A dangerous idea could be very controversial, completely novel, blue-sky thinking, or something that challenges current thinking. But it must also demonstrate a commitment to moving the idea forward.1

Every year, I attend to listen to these ideas and witness the controversies that unfold. No one is indifferent to statements like “Stop telling people to lose weight”1; “Making family physicians primary in primary care guidelines”2; or “Prescribing income.”3

If there were even the remotest chance that my dangerous idea would make it through, I would propose the following: Stop invoking evidence-based data as though it guarantees certainty.

Consider the case of corticosteroid injections for knee osteoarthritis discussed in “Top studies relevant to primary care practice.”4 It tells us that “steroid injections might marginally ... increase erosion of knee cartilage” (page 280).4

This is news that will surprise more than a few people, considering the procedure is fairly standard, has been performed by physicians for decades, and appears to provide relief to patients suffering from knee osteoarthritis, for whom other therapeutic methods have proven ineffective.

The authors have tried to reinterpret the results by casting doubt on their clinical significance, alleging that the tests’ timing was suboptimal and that several previous studies have demonstrated that cortisone injections are effective. However, this interpretation does not correspond with the conclusions drawn by these researchers:

Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.5

These results are not very reassuring: no physician wishes to use a treatment that is ineffective or creates further erosion in already deteriorating knee cartilage.

The recommendations published on this procedure are contradictory: The American Academy of Orthopaedic Surgeons states that “We are unable to recommend for or against the use of intraarticular corticosteroids for patients with symptomatic osteoarthritis of the knee”6; the American College of Rheumatology opines that “We conditionally recommend that patients with knee [osteoarthritis] should use … intraarticular corticosteroids injections.”7 Tools for Practice states that “Corticosteroid intra-articular knee injections reduce osteoarthritis pain [about] 40% more than placebo and one in every 3-5 patients injected will have global symptom improvement in the first four weeks.”8 In short, these are contradictory recommendations that leave clinicians to their own devices, even though they claim to rely upon evidence-based data.

To prove my point, I could have just as easily discussed prostate cancer screening or annual medical examination recommendation sagas that have seen credible organizations publish contradictory recommendations while relying on the same evidence, claiming that their opinions are evidence-based. Evidently, the GRADE system upon which most of them depend, does not do much to help the cause, given that it allows recommendations to be classified as strong despite weak supporting evidence.

Supposed evidence-based opinions remind me of insurance policies that include a fine-print clause on when coverage ceases to apply; with scientific evidence, there are always justifications as to why interpretations vary or recommendations contradict each other.

So, let us stop constantly invoking evidence-based data as though it guarantees certainty.

What a dangerous idea!

Footnotes

  • Cet article se trouve aussi en français à la page 247

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Hale I
    . Fantastic idea: stop telling people to lose weight. In: Dangerous ideas. Top 3 proposals presented at Family Medicine Forum. Can Fam Physician 2018;64:97-8. (Eng); e56–8 (Fr).
    OpenUrlFREE Full Text
  2. 2.↵
    1. Allan GM
    . First place: making family physicians primary in primary care guidelines. In: Dangerous ideas. Top 4 proposals presented at Family Medicine Forum. Can Fam Physician 2016;62:120-1. (Eng), e61–3 (Fr).
    OpenUrlFREE Full Text
  3. 3.↵
    1. Raza D,
    2. Pinto AD,
    3. Bloch G,
    4. Tomlinson KC
    . First place: prescribing income—reimagining our ability to act on the most powerful determinant of our patients’ health. In: Dangerous ideas. Top 4 proposals presented at Family Medicine Forum. Can Fam Physician 2015;61:117-9. (Eng), e73–5 (Fr).
    OpenUrlFREE Full Text
  4. 4.↵
    1. Perry D,
    2. Kolber MR,
    3. Korownyk C,
    4. Lindblad AJ,
    5. Ramji J,
    6. Ton J,
    7. et al
    . Top studies relevant to primary care practice. Can Fam Physician 2018;64:280-5.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. McAlindon TE,
    2. LaValley MP,
    3. Harvey WF,
    4. Price LL,
    5. Driban JB,
    6. Zhang M,
    7. et al
    . Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis. A randomized clinical trial. JAMA 2017;317(19):1967-75.
    OpenUrl
  6. 6.↵
    1. American Academy of Orthopaedic Surgeons
    . Treatment of osteoarthritis of the knee. Evidence-based guideline. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons ; 2013.
  7. 7.↵
    1. Hochberg MC,
    2. Altman RD,
    3. Toupin April K,
    4. Benkhalti M,
    5. Guyatt G,
    6. McGowan J,
    7. et al
    . American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64(4):465-74.
    OpenUrl
  8. 8.↵
    1. Jamieson J,
    2. Allan GM
    . Corticosteroid shots and knees: a match made in osteoarthritis heaven? Edmonton, AB: Tools for Practice; 2015.
PreviousNext
Back to top

In this issue

Canadian Family Physician: 64 (4)
Canadian Family Physician
Vol. 64, Issue 4
1 Apr 2018
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Stop invoking evidence-based data!
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Stop invoking evidence-based data!
Roger Ladouceur
Canadian Family Physician Apr 2018, 64 (4) 246;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Stop invoking evidence-based data!
Roger Ladouceur
Canadian Family Physician Apr 2018, 64 (4) 246;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • Top studies relevant to primary care practice
  • Arrêtez d’invoquer les données probantes!
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Commentary

  • Toward an identity and team-based practice rooted in transdisciplinarity
  • Task sharing, community health workers, and Canada’s primary care crisis
  • Increased proportion of family medicine residents did not want to be family physicians
Show more Commentary

Editorial

  • Solving the family medicine crisis
  • Résoudre la crise en médecine familiale
  • Pride and learning in reverse
Show more Editorial

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire