So, it's been really interesting looking at how Evidence Based Medicine is often seen as the 'gold standard' and that much treatment today is based on the latest (or in some instances, not so new) research. The concept of EMB is great and as discussed in the 'benefits of EBM' posting, has brought about some wonderful changes. But it is worrying that there is a risk of use of EBM when the evidence base is not so strong, bias or is used solely in making decisions. One author has written that they have concerns about the way trials are often presented with an overwhelming arrogance as if they provided the truth, the whole truth and nothing but the truth about specific clinical questions. But it was pointed out that even the best trials never tell the whole truth.
So should we be concerned about the methods used for researching certain clinical issues? For example, Randomised Controlled Trials- frequently described as the best available, which even when randomised and controlled, will have specific inclusion and exclusion criteria.
One of the things we had spoken about before is how it takes individuality out of the care given to patients. There are two ways of looking at this- Firstly whether the findings of trials can be extrapolated to wider groups of patients not included in the trials. Secondly, as Trish had discussed her Afghan patient, when care pathways are designed as a result of Evidence Base, patients who need an individual response may find themselves being given standardised, possibly harmful, care.
I would like to leave this open for discussion and leave you with a couple of light hearted opinions of EBM as food for thought (taken from the website below)-
'The science that we push has money attached to it'
'much of the 'Evidence' today is doctored and fabricated by Big Pharma
'I see EMB as a way of 'dumbing down' medicine to allow NP's to try to practice medicine'
'EBM is a “cookbook”. One size fits all. Experience and years of training does not matter'
'EBM is the new religion'
Some more rational opinions from the same website-
'EBM should be used as a tool in the decision making process, but should not be deferred to in place of independent thinking nor considered a gold standard not to be deviated from.'
'EBM is a well-meaning and useful concept if tempered with judgment and judicious application. My challenge with it is that it has been turned into a religion, and we physicians are supposed to worship at its alter without the addition of any critical thinking.'
http://www.sciencebasedmedicine.org/index.php/how-do-you-feel-about-evidence-based-medicine/
'What is right and what is wrong about evidence based medicine? http://www.ncbi.nlm.nih.gov/pubmed/12950509