Come ye, worship at the shrine of evidence! Evidence will fix medicine.
What do I hear blasphemers? Bah humbug?
Some are challenging the religion of EBM – Evidence Based Medicine proponents need to watch out for their friends and A contrarian view of evidence based medicine
I like some aspects of EBM. We should search for the best possible evidence to support our medical decision making. However, like all religious movements, extremism in support of EBM misses the entire point of EBM. We should not eschew the best evidence, even when that evidence does not meet the “highest” standards. We should not become nihilists when randomized controlled trials do not exist.
We should strive to find the best evidence, but never forget common sense and clinical judgement. EBM works better for groups than it may for an individual patient.
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{ 2 comments… read them below or add one }
In my opinion, EBM is what separates the medical profession from chiropractors, homeopaths, naturopaths, and all of the other “alternative medicine” practitioners who compete with us for patients and a piece of the third party reimbursement pie. Medicine must continue to strive to be primarily a scientific profession, and all the EBM movement is saying is that we must strive to evaluate what we do by the gold standard of the scientific method. We may not be able to scrutinize everything that we do to the highest level of this standard, but at least we should maintain this as our goal. If we do not, we will have to compete at the level of the herbal huxters on late night TV.
There are two problems with EBM as it is being procticed IMO. 1) people are forgetting that the absence of evidence is not evidence of absence. For example no-one is going to perform a PRDB trial of operating or not operating for appendicitis. Doesn’t mean that appendectomies are not useful operations. and 2) People are COMPLEX; as I believe you’ve pointed out all the PRDB drug trials are on patients with one problem. But no-one has any evidence on what do to with the patient with HTN, DM, COPD, CAD, PVD, and lupus. It is the rare paient (at least in my practice) that only has one disease process. EBM has made little inroads on the multiple comorbid disease patient. Furthermore it will never make inroads on the (majority?) of people who can’t (or refuse to ) take 12 medications on different time schedules properly (or at all).
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