Here's a nice blog to get us all started on this debate
Thank you Trish,
Let’s start our discussion. Here is a brief overview and some benefits of EBM.
The most common definition of evidence-based medicine, that I came across when I was looking through the academic papers, was one suggested by Trisha Greenhalgh and Anna Donald and was defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." In other words, evidence-based study seems to be the process of using individual clinical expertise with external clinical evidence from systematic research in order to deliver the best clinical care to patients.
One of the significant benefits of EBM is that using of the evidence based practice allows the clinician to adapt treatment to the conditions and risk–benefit profile of the individual patient, which in turn, leads to better health outcomes. In addition, because evidence-based medicine looks at all the research that is done about a disease or treatment, using guidelines written by experts from all over the word seems to be more effective method of diagnosis and treatment.
There are a lot of examples in favor of using evidence-based medicine, which demonstrate that changes in treatment of some diseases (based on health-based practice) led to better health outcomes. For instance, resting in bed used to be recommended for many conditions. But studies have shown that it can often cause more harm than good. People who have had a heart attack, for example, do better both physically and mentally if they begin exercising as soon as they feel well enough.
According to Centre For Evidence Based Medicine (CEBM) there are five steps, which lead to evidence-based practice:
- Asking Focused Questions: translation of uncertainty to an answerable question;
- Finding the Evidence: systematic retrieval of best evidence available;
- Critical Appraisal: testing evidence for validity, clinical relevance, and applicability;
- Making a Decision: application of results in practice;
- Evaluating Performance: auditing evidence-based decisions;
In addition, it is suggested that the effective practice of evidence-based medicine requires including patients in medical decision-making process, by increasing the degree of their health literacy.
However, the approach is not without its opponents. One of the main arguments against this method is its difficulty to implicate it into routine practice caused by lack of necessary skills among healthcare professionals who are struggling to act according with new guidelines.
Here are the links of BMJ article and CEBM website, which i found useful:
http://www.bmj.com/content/312/7023/71?view=long&pmid=8555924
Thanks Nino..
This house believes EBM isn’t all that great!
EBM has been a revolution and paradigm shift in clinical practice and thinking. Countless guidelines have been published by groups such as NICE and many more are certainly to com. Guidelines are undoubtedly part of good clinical practice and are a way of standardising good quality healthcare across various clinical settings. However, should these guidelines be absolute? If so, how valid are they? Or are there various leeways (flexibilities) that clinicians/health professionals can practice within?
EBM does clearly has its advantages, I don’t think there is much point discussing the technical faults that EBM can have. However, there are other multidimensional effects of EBM practice. Below are a few points:
My main issue with EBM is the validity and reliability of the data provided as a basis for clinical practice. Vested interests and pharmaceutical funding can influence the findings of such data.
http://theconversation.edu.au/pharmas-influence-over-published-clinical-evidence-5325
Often, positive findings are more likely to be published than negative findings. This can have detrimental effects on clinical decision making.
http://www.ted.com/talks/ben_goldacre_what_doctors_don_t_know_about_the_drugs_they_prescribe.html
EBM generally uses quantitative research, this usually comes from RCTs but are RCTs are not relevant for all treatment settings e.g. prognostic questions in pregnancy rates following IVF. Moreover, there is often a lag time between conducting the RCT and publishing, could this effect clinical practice?
These studies may not be representative of all studies in the field. They might only be relevant to a certain population/ethnicity. Guidelines published in the UK may not be applicable to other countries worldwide.
For example, TB diagnosis in the UK may include Sputum sampling, CXR, Mantoux test BUT in countries such as Bangladesh there may not be the resources available to carry out routine CXRs/Mantoux tests. EBM works best when there are infrastructural elements to the health care system. EBM requires funding and in lower income countries this could open the door to Pharmaceutical companies taking advantage.
1) Validity and Reliability of the data
2) Pharmaceutical funding
3) What gets published
4) RCTs seen as gold standard method of data collection for EBM
5) Reproducible worldwide
