I shall be writing a summary for this weeks virtual seminar in due course.
Thanks Moaize
BENEFITS OF EBM
-“the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions” (Rosenberg et Donald, 1995).
-quite simply common sense to act on the best evidence that we have
-almost intuitively obvious –‘having used too much salt for a wok once, I tend to be very careful with salt now’
-doctors need to cite evidence to explain their chosen treatment plan if taken to court
DISADVANTAGES
-a myth of infalibility of RCTs? problems could be solved by increasing transparency in medical trials, limiting/regulating/monitoring pharmaceutical companies’ roles in medical research; but will never be perfect
-discounts the patient as an individual –there are no trials for every single type of patient that walks through the door –depends on generalisability of trials
-no such thing as ‘pure EBM’, which begs the question, will there ever be?
-slippery slope to believing if there is no scientific evidence proven in a trial for something then this means this theory can be disregarded (scientific rationalism)
-maybe this is more of a subconscious thing by the doctor? Especially as medicine is taught with a strong biomedical emphasis and it is the current prevailing school of thought
-at the very least doctors need to be self-aware of why they approach their profession the way that they do
-a reflection of a more general wider shift in society towards this philosophy
-seen as required for a modern society: ‘The key to human progress and social order is
objective knowledge through scientific exploration and rational thinking’….’Assumes that social and natural worlds follow laws that may be measured, calculated and therefore predicted’ (taken from lecture)
-this is reflected in the biomedical approach, and we need to be aware of the implications of this. This could be dangerous because it leads to a tendency to ignore aspects of patient care not proven in a trial e.g. social determinants of health
-effect of doctors feeling devalued, having to follow guidelines –are they being dumbed down?
-nothing wrong with EBM as a concept, but there are limitations with how it is carried out e.g. influence of pharmaceutical industries
-'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 altar without the addition of any critical thinking.'
Nice summary Moaize, thanks. I particularly like the last point, which seems to sum up debate about EBM quite nicely!
