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
