What Is Evidence-Based Medicine?
Although few doctors want to admit it, medical information has varying degrees of reliability. For example, anecdotal data is essentially just one or a few patients’ experiences, and because it is so subjective, it has very little scientific merit.
On the other hand, information that has been collected from a scientific study that meets the highest empirical standards is likely to apply to many more patients and is probably much more reliable. This kind of medical information should be used to make decisions about treatment in what is known as evidence-based medicine or EBM.
The Basics of Evidence-Based Medicine
At its core, evidence-based medicine is about making clinical decisions based on a hierarchy of scientific data. However, patient care, even evidence-based medicine, should never just be about performing a procedural algorithm; evidence should serve as one foundation for care, but the individual’s personal needs should remain an important consideration.
A more fundamental question for health care providers should be: “What is reliable evidence?” Two metrics help determine the dependability of evidence: quantity and quality. There may be a plethora of sources confirming a scientific tenet which can create a consensus among a professional community, informing a standard operating procedure. Widespread agreement does not guarantee accuracy, but it tends to point to the best evidence available and should add weight to a therapeutic option.
The other principal metric for evidence is quality. Within the scientific community, the lowest quality data includes case studies, non-peer reviewed publications, manufacturer data or expert opinion. Just a bit more credible than these are non-randomized controlled trials. Superior to non-RCT data is, of course, randomized controlled trials, but at the pinnacle of the evidence hierarchy is a meta-study of RCTs. Obviously, this suggests that evidence that is unbiased and taken from a large sample size is more reliable.
A History of Evidence-Based Medicine
Although the term “evidence-based medicine” was only recently coined in 1990, medicine has a long history of relying on scientific inquiry to inform clinical decision-making.
In 1662, Jan Baptist van Helmont first introduced the concept of a controlled clinical trial. He suggested taking a population of 200 or 500 people and randomly selecting half to undergo bloodletting. The other half would not undergo bloodletting instead receiving the best available care.
James Lind published in 1753 the results of the first controlled clinical trial involving sailors aboard the HMS Salisbury. The sailors were separated into 6 groups and given various treatments for scurvy.
In the latter half of the 20th century, various researchers brought to bear critical analytical tools that verified medical practices were founded on sound scientific research. A widespread re-examination of clinical practices that were rooted in tradition rather than science took place during this period.
Between 1993 and 2000, the Evidence-Based Medicine Working Group at McMaster University developed principles for utilizing medical literature.
Weaknesses of Evidence-Based Medicine
Evidence-based medicine may appear to be the gold standard for practicing medicine, but there are some fair critiques of it. It is important to keep in mind these weaknesses when following any medical recommendations.
- Applying the general to an individual– evidence-based medicine primarily relies on studies of large populations to obtain a sense of how most people respond to a medical practice. This may provide an insight into the general population, but it may not apply to a unique group or individual.
- EBM is expensive—because randomized controlled trials are so expensive, they can only be used for select therapies. In many circumstances, physicians will have to risk extrapolating study results to their unique clinical setting.
- Bias is pervasive—although researchers should make every effort to remove bias, it is still pervasive in the funding process, industry regulations and academic community.
- Burden of ongoing education—it isn’t apparent to most patients, but health care providers must be constantly learning about the latest medical studies to provide their patients with the most effective advice and services.
- Delayed application—there are considerable delays between when studies are performed and the results published, as well as between publication and adoption by the professional community. During this period, less optimal practices are used that could downgrade patient outcomes; a more relaxed set of standards for publication and implementation could save lives.
- Patient values—although some consideration of the patient’s preferences is embodied in the philosophy of evidence-based medicine, in practice, it is given relatively little weight. The issue of ignoring patient concerns is widespread in the medical education system.
There are many more potentially specific flaws in medical evidence that may make evidence-based medicine more unreliable than it initially appears. Most of these involve possible bias in the research or implementation processes.
Why You Should Trust Evidence-Based Medicine
Despite the potential for some problems in the evidence-based medicine system, it remains the most reliable medical practice framework currently available. EBM as a system has been compared to non-EBM practices and there are some clear advantages.
- Disease outbreaks—collecting patient information and using AI tools to analyze it can help health care providers more readily recognize and respond to the start of a disease outbreak including influenza.
- Reducing readmissions—EBM enables providers to identify problematic patterns that are leading to hospital readmissions.
- Streamlining treatment—because evidence-based medicine gathers industry best practices, physicians can pinpoint a set of symptoms and immediately be presented with possible diagnoses and most effective treatment options.
- Reduces medical errors—because medicine becomes standardized across large populations, physicians have an optimized plan of attack that minimizes the use of risky therapies.
- Lowers costs—although few doctors want to talk about costs of services, it is an important consideration for most patients and health care organizations. EBM saves money by expediting the diagnosis and treatment phases; patients have fewer but more meaningful visits because providers can zero in key symptoms more readily.
- Improved patient outcomes—the sooner your doctor can identify the health issue, the sooner she can apply the most effective therapies. This typically produces a better outcome for the patient.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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