Against evidence-based medicine

Against evidence-based medicine

by Deleted user -
Number of replies: 9

Evidence-based medicine is a “brave new world”, promoting a disturbingly unidimensional approach to clinical situations that are often vastly complex. It is a “one size fits all” approach that neglects the psychosocial dimensions imperative to clinical practice, and will in fact be detrimental to patient care in the long-term.

What are everyone's thoughts on the matter? Is it really as "conscientious" and "judicious" a use of current best evidence, as Sackett defined it to be? Or are there more negative aspects to the medical mantra that is EBM? 

In reply to Deleted user

Re: Against evidence-based medicine

by Deleted user -

I totally agree with you, Sarah. In my opinion, EBM might be detrimental to the patient care. It might also reduce the ability of the clinicians to attain exprience, as it is sometimes needed to get off the beaten track in order to find new solutions. I think that it is a mistake to say that EBM is a "paradigm shift" that will change the medical practice from now on.

Regarding your question about the negative aspects of EBM. I think it has many negative aspects. For instance, the results it creates cannot be valid for all treatments. Also, RCTs are expensive, which means it needs external funding which might lead to bias in order to satisfy the sponsor.

I think EBM might create more limitations for the health care sector rather than being beneficial for the patient care.

In reply to Deleted user

Re: Against evidence-based medicine

by Deleted user -

Hello Sarah and Harby. Well I am not against your opinions however; I believe that Evidence Based Medicine has more positive effects than the negative effects. :)

 EMB is defined as “ the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients”  ( Greenhalgen, Donald 2012). I totally agree with you Harby that RCTs are expensive and there are chances of biasness and EBM creates limitations especially for the doctors. However, I think that, the doctor uses his or her experience and education, along with EBM guidelines, to make informed medical decisions.

In my opinion, using evidence based guidelines benefits all. Both the doctor and patient decide a treatment based on the most proven science available. It is being applied not only to pharmaceutical treatments but also to surgical interventions and medical advice. And the effectiveness of using EBM has proven itself repeatedly. Moreover, EBM considers the evidence of risks as well as benefits of treatment and diagnostic tests. And the evidences change with time that is; if a medicine found to be less beneficial it is then shifted or changed. So, though it restricts the doctor’s creativity to a certain extent however, its positive effects shouldn’t be ignored totally. :)

In reply to Deleted user

Re: Against evidence-based medicine

by Joseph Daniel Jameson -

Esha, I agree that EBM is likely to have more beneficial than harmful effects on patient care. But only in the short term. You said that a doctor should use their experience and education, along with EBM, to inform clinical decisions on specific patients. Again, I agree. However, my concern is that current medical education and further training of junior doctors is increasingly based on EBM and that there will be a loss of experience in 'clinical judgement' as young doctors are more scared to deviate from evidence based guidelines and increasingly scared of making mistakes. Doctors will no longer learn to use their intuition and EBM will be dterimental to patient care in the long term as we train less 'experienced' doctors.

What do others think?

In reply to Joseph Daniel Jameson

Re: Against evidence-based medicine

by Deleted user -

I agree with you, Joe. I think that EBM will be only effective on short term basis, because it allows 'quick wins', but does not ensure real development of the medical practice. Moreover, we should keep in mind that medicine is a humanitarian science, which means, that we cannot skip the importance of the psycho social elements and the 'human touch'. We might consider that  EBM is essential for junior doctors  as they did not  attain yet enough experience and the courage to try their own methods, but on the other hand, if they only rely on EBM, how are they going to develop those skills in the future? If we assume that EBM is the answer for all the medical problems, this would be like an automated medical care which cannot fit everyone and finally we will get medical professionals who have limited point of view, especially having in mind that in the field of medicine every day there is a new invention and a new discovery which is based on clinical trials. 

In reply to Deleted user

Re: Against evidence-based medicine

by Lindsay Jane Bull -

I agree with you too. When I read this question, my immediate response was 'of course EBM is good'.

However, thinking about this in more detail made me realise that there were a number of pitfalls to it. I agree that it is a 'one size fits all' approach and as Trish discusses in her article, it encourages doctors and health professionals to act without using practical and moral judgements, and as you have mentioned, it ignores psychosocial aspects of health. 

I don't think EBM should be completely disregarded, far from it. But I think it should guide decision-making, rather than dictate a specific direction. 

In reply to Deleted user

Re: Against evidence-based medicine

by Deleted user -

i totally agree with you.EBM devalues the importance of practitioner experience and tacit knowledge and may not necessary work as most RCTs are so controlled that the participants and clinical environment bear little resemblance to the average healthcare setting and recipient. In real practice, Professional judgement is always required.

 EBM is also about generalizability. For instance, the result of the EBM process, will tell practitioners what the likely overall outcomes will be if 100 or 1000 individuals with a condition are cared for in a particular way. The individual client is lost within the numbers; for example, you may know that from 100 women using a birthing ball 70 will have a normal birth, but it will not tell you if the woman in front of you will or not.

In reply to Deleted user

Re: Against evidence-based medicine

by Deleted user -

What a dubious issue! I am not a medical student but I consider medical knowledge as something broad and revolutionary. I am always in favor of advances and new treatment methods. I understand that guidelines are useful for good medical practice but they should not be absolute. What about individuality??? Each patient is different so not all patients should be faced in the same way. I guess that a balance may be the way. Also, both social and psychological factors should be taken into account. I really can't think of how I would react if I was a doctor, so maybe you as doctors could tell me. I am simply wondering how easy it would be to implement EBM into routine practice and how well prepared are clinicians for that.

In reply to Deleted user

Re: Against evidence-based medicine

by Tahir Mir -

I agree to the criticism of this ‘one size fits all’ approach. A clinical decision needs to be made in context of a particular situation. Evidence of an approach may be valid; however variation is present in each patient in regards to the equilibrium of benefits and risks, patient’s values and preferences, along with the availability and costs of treatment.

Also the practice of evidence based medicine is not consistent even if evidence is agreed upon. Guidelines on low back pain in the UK, US, New Zealand and Holland were published around the same time and agreed upon the effectiveness of spinal manipulation. However, recommendations to practice were different.

Jonas WB. Scientific evidence and medical practice. The “Drunkard’s Walk”. Arch
Intern Med 2009;169:649-50.

In reply to Deleted user

Re: Against evidence-based medicine

by Deleted user -

Although evidence based medicine brings some beneficial effects to the disease researches, there are some limited supplies in some cases.

Sometimes none of evidences can prove whether the treatments are effective even using the modern and latest methods to treat ‘big epidemics’ in the world. For example, according the EBM shows that the sick leave of back pain is taken one third in all sick leaves in the world and all of 128 treatment methods of back pain are no effectual which contain the different levels in price (lowest price to highest price). ( The information from the web of Chinese Cochrane Centre )

So, generally speak, solving some decease issues depend on the high quality, large-scale clinic research and doctor’s observational result than in the EBM.