The Rise, Fall, and AI-Powered Rebirth of Evidence-Based Medicine | Dr. Richard Lehman & Dr. Raj Mehta

“You know, what if they were to actually put it’s [AI] mind to a science of practical compassion for everybody?… if the right machines were to come along and help us do it, that's going to be a fabulous thing.”Dr Richard Lehman is a retired GP from Oxfordshire who had a "ringside seat" to the birth of evidence-based medicine, previously held academic positions at Oxford and Yale, later becoming Professor of Shared Understanding of Medicine at the University of Birmingham. Dr Raj Mehta is a physician and evidence-based medicine educator who views EBM as essential heuristics for discerning truth in clinical practice. Together, they bring decades of experience wrestling with how we know what works in medicine, from the historical foundations laid by James Lind's scurvy trials to the AI revolution that promises to transform how we synthesise and apply medical evidence.Key TakeawaysTruth-seeking requires method, not just conviction: Before EBM, medicine operated largely on "conviction-based" approaches collected in massive textbooks. The shift to systematic evidence evaluation transformed how we separate opinion from fact in clinical practice.Numbers Needed to Treat illuminate magnitude: Tools like NNT help clinicians and patients understand effect sizes. Context and timeframe matter enormously.AI could democratise and personalise evidence: Rather than replacing doctors, AI might enable real-time synthesis of evidence matched to individual patients, creating feedback loops between treatments and outcomes at an unprecedented scale.The evidence map has gaps and mountains: Current evidence is like an 18th-century road atlas - some areas well-mapped, others blank. AI could be the "sat nav system" for medicine that acknowledges uncertainty while guiding decisions.Social determinants still trump beta blockers: While we refine molecular treatments, the biggest health impacts remain at the policy level - safe neighbourhoods, warm homes, and social conditions. Medicine must embrace "practical compassion" beyond prescriptions.Where to Find Our Guests* Dr. Richard Lehman (X/Twitter)* Dr. Raj Mehta (X/Twitter)In This Episode00:00 - Introduction: Why evidence-based medicine matters now more than ever02:54 - The scientific method in medicine: Discerning truth from fiction in clinical practice06:06 - James Lind and scurvy: The 200-year gap between discovery and adoption12:01 - Bradford Hill and the RCT revolution: Moving from mechanism to measurement14:29 - Richard's ringside view: When "evidence-based medicine" arrived in Oxford19:10 - The limits of population evidence: Why Numbers Needed to Treat aren't enough22:39 - Shared decision-making complexity: The overwhelming challenge of multimorbidity26:00 - The AI revolution: From medical scribes to comprehensive evidence synthesis29:39 - Patient empowerment in the age of monetised medicine36:43 - The pre-Copernican challenge: Are we just getting better at measuring the wrong thing?39:01 - China as a sandbox: Where innovation might overtake Silicon Valley44:54 - Beyond beta blockers: Why social determinants still matter most54:10 - COVID-19's mixed report card: EBM's triumphs and failures in crisis59:04 - Communicating uncertainty: The topographical map of medical evidence1:01:39 - Looking forward: Why this is a "fabulous time in medicine"Referenced* Richard Lehman’s weekly review of medical journals (Link)* James Lind Library (Link)* Richard Lehman on Evidence-Based Medicine (Podcast)* The RECOVERY Trial (COVID-19 treatment comparison) (Link)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at [email protected] Attribution: Music by AudioCoffee from Pixabay.😯 Hey there!Found this discussion on evidence-based medicine thought-provoking? Share it with your colleagues and discuss your take on the current state of evidence based medicine. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com

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