Benefits of EBM

Benefits of EBM

by Deleted user -
Number of replies: 6

Thank you very much Trish for posting the link to the article. I enjoyed reading it!

Before prescribing a drug to a patient, I always want to be aware of its effects and side effects. Evidence based medicine provides us with the clinical evidence of these effects.

In EBM, practitioners can rely on nationwide guidelines that have been set by experts from all over the world. These guidelines are based on the results of randomised controlled trials, systematic reviews and meta-analysis.

Rosenberg et Donald describe evidence based medicine as “the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions” (Rosenberg et Donald, 1995).

In the article Trish posted, there are two good examples of health improvements through EBM:

Venesection (bleeding) had been a treatment option for many diseases over hundreds of years. Only in the 1820s Pierre Louis compared the clinical outcomes of patients treated with venesections and without. He could prove that venesections actually worsened patients’ health status. Only because of his findings venesection therapies stopped.

In the 1960s Richard Doll ran one of the first RCTs. He showed that streptomycine could treat tuberculosis (TB). How would we treat TB today if there were no RCTs and EBM?

In reply to Deleted user

Re: Benefits of EBM

by Deleted user -

    First of all, I agree with your opinion and I cannot argue about the merit of evidence- based medicine. As you mentioned, evidence- based medicine is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients (Rosenberg, Donald, 2005). As Trish refers to her book that evidence- based medicine requires you not only to read papers, but to read the right papers at the right time, and then to alter your behavior in the light of what you have found. There are many examples of EBM, such as management of fever in children or the use of heparin in venous thromboembolic disease, etc.

     After reading Trish’s book, How to read a paper, The basics of evidence- based medicine, I would like to extent my comment and refer how slow the health professionals adopt EBM and how difficult is by educational approaches to promote EBM.  From a sociological aspect, this resistance by health professionals indicates me, generally, how challenging is from the theory to convert into practice a social movement. People hesitate to accept easily an innovation not only in medicine, but generally in every part of their lives, so further information and understanding about what evidence based medicine is and is not, is necessary.

In reply to Deleted user

Re: Benefits of EBM

by Deleted user -

I am a strong supporter of EBM, not necessarily because of ideology but because of the lack of 'something else'. In my opinion, the term evidence-based medicine has been repeatedly interpreted, established and stretched far too often. Looking at EBM from a simple point of view: we use medicine based on experience. Whether this experience was made by others in a long and extensive trial or by ourselves when dealing with patients on a daily basis, we use our knowledge and experience. Being overly sarcastic here, after having used too much salt for a wok once, I tend to be very careful with salt now. I wouldn't really call that evidence-based cooking. It is not the idea behind EBM that bothers me but the overuse of the term and the constant dispute about its necessity.

A short comment on venesection. This form of treatment is today, of course, not nearly used as often as it was two hundred years ago, but it still remains to be the simplest and most effective way of treating haemochromatosis (iron overload).

In reply to Deleted user

Re: Benefits of EBM

by Samuel Dafydd Rigby -

After having looked over the readings this week and attending the lecture I find my feelings regarding  EBM are mostly feelings of respect and frustration. I believe that the principles of EBM are good, that decisions should be made upon good evidence, naturally. In every field, including fine arts, what has come before has informed work of the present. Even if a change away from the status quo is to occur, is that not on the basis that there is some sort of evidence to suggest that the status quo is flawed in some way? 

My frustration stems from the fact that EBM is not considered appropriate on the basis that it limits clinical decision making processes which include the patient as an individual. Does the use of 'based' in EBM suggest that evidence is not the sole determinant of outcome? Furthermore it seems that the issue is not necessarily with evidence itself, but rather lack thereof. If there was a sufficient bank of evidence for there to be ample information on each individual case would this discussion need to be had, would EBM not be unquestionably ideal? Granted a hypothetical situation, I feel the question of whether EBM is just a passing trend or not could be replaced with the question, do we have the resources available to commit to the dream of pure EBM? 

In reply to Samuel Dafydd Rigby

Re: Benefits of EBM

by Sara Shaw -

Ah, interesting. So, what does a pure EBM look like? Is it actually possible? And, if so, what resources do you think would be needed to make the dream come true?

In reply to Deleted user

Re: Benefits of EBM

by Yasin Fatine -

Thank you Mr Freitag! Put it better than my attempt in the other thread. I don't think the problems associated with EBM give you enough ammunition to call for its abolition, but addressing the individual problems, such as by increasing transparency in medical trials, possibly limiting/regulating/monitoring pharmaceutical companies' roles in medical research. But I don't think a 'pure' EBM world would be a good one; there always has to be room for individual physicians' opinions and preferences, based on experience of course, but even that may be guided by EBM. I mean, why would a doctor insist on continuing giving a certain treatment when there is irrevocable evidence saying it doesn't work? Unless they're extremely stubborn...

In reply to Yasin Fatine

Re: Benefits of EBM

by Sandeep Suryadevara Rao -

I think 'pure EBM' (as described above) would mean having a database into which a patient (or a broker for a patient) could type in their presenting problem with numerous other details, and the computer could find data that dictates the best treatment path for that 'individual' person. So after typing in their symptoms they may type in their:

Age, sex, height, weight, medical conditions, medications, eye colour, hair length, favourite food, the name of their dog

and the computer would generate a list of treatment options with percentages for success, as well as a list of side effects (and probability of developing them)

With regard to the overall thread, are we not sometimes referring to guidelines specifically, rather than evidence based medicine?? I certainly think that physicians often feel devalued when they feel they have to disregard their own training and follow a guideline. They can see it as being beneath them. I however, think that guidelines are a good thing.

And to a great extent I think that clinicians must cite 'evidence' to defend their treatment plans, because that is what the lawyers will asking for when they meet in court