Evidence-based medicine

Evidence-based medicine is a medical movement based upon the application of the scientific method to the whole body of medical practice, including long-established existing medical traditions that may never have been subjected to systematic scrutiny. According to the Centre for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

Table of contents

1 Overview
2 History
3 Criticism of evidence-based medicine
4 See also
5 External links

Overview

Using techniques from science, engineering and statistics, such as meta-reviews of the existing literature, risk-benefit analysis and randomized controlled trials, it aims for the ideal that all doctors should make "conscientious, explicit, and judicious use of current best evidence" in making decisions about the care of individual patients.

Evidence-based medicine argues that it is impossible to use testimonials, hearsay and mystical arguments as proof because observer bias distorts recollection.

Practising evidence-based medicine implies not only clinical expertise, but expertise in retrieving, interpreting, and applying the results of scientific studies, and in communicating the risks and benefit of different courses of action to patients.

For all its problems, evidence-based medicine has very successfully demoted the ex cathedra statement of the "medical expert" to the least valid form of evidence — all experts must sprinkle their pronouncements with references to the relevant literature.

History

Professor Archie Cochrane was a British medical researcher whose book Effectiveness and Efficiency: Random Reflections on Health Services (1972) and subsequent advocacy caused increasing acceptance of the evidence-based medicine concept. Cochrane's work was honoured through the naming of centres of evidence-based medical research — Cochrane Centres — and an international organisation, the Cochrane Collaboration.

Criticism of evidence-based medicine

Critics of evidence-based medicine state that doctors were doing these things already, that good evidence is often deficient in many areas, that lack of evidence and lack of benefit are not the same, and that the more data are pooled and aggregated the more difficult it is to compare the patients in the studies with the patient in front of the doctor. ( "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand." (Tonelli MR: The limits of evidence-based medicine.)) Evidence-based medicine seems to them to discount the value of the case study.

The primary problem is that evidence-based medicine is most effective when testing the effectiveness of drugs and may not be appropriate for other forms of treatment, particularly those requiring the active participation of the patient. Some treatments take a more holistic approach, which may be difficult to fit into a testing model that assumes the patient is a passive object acted upon by the treatment.

Critics also raise conflict of interest. Journals such as the New England Journal of Medicine, The Lancet, JAMA, and the British Medical Journal have been unable to prevent papers ghostwritten by pharmaceutical companies from being published. These same pharmaceutical companies are a primary source of funding for medical and drug research. In some cases, doctors listed as authors on ghostwritten research papers did not review the raw data, only tables compiled by a medical writing company. (See also Flanagin A, Carey LA, Fontanarosa PB: Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals; Larkin M: Whose article is it anyway?)

Some critics also claim that evidence-based medicine seems more concerned with the job security of researchers than with solving health problems.

Long before evidence-based medicine came along case-studies were an acceptable form of medical research. Case study methodology can be applied effectively to the study of men with chronic coronary heart disease, for example. ''"Case study methodology can be used as a creative alternative to traditional approaches to description, emphasizing the patient's perspective as being central to the process. Contemporary practitioners and researchers have come to appreciate the subjective richness of patients recounting their experience and the meanings implicit in them to help guide practice." ( Zucker, DM: Using Case Study Methodology in Nursing Research) The importance of the individual patient in the case study method runs counter to evidence-based medicine's emphasis on population evidence.