A colleague jousts with me

One of my colleagues has this to say about my opinion piece in Virtual Mentor. I respect him greatly, but I believe his is missing the problem here.

I read DB’s piece on Virtual Mentor and must say DB argues against EBM but in his argument he argues for exactly what the current EBM principles and definition espouse.

The current EBM definition (see ACP Journal Club. 2002 Mar-Apr;136:A11.)
begins with the patient’s preferences and actions which is combined with the clinical state and circumstances in which we work and the pt exists, and research evidence ALL tempered by our clinical expertise.

I dont understand why critics of EBM (and I consider DB one of them) dont get it– they just dont understand (or will not acknowledge) the current (as of 2002) conceptualization of EBM. They all argue that EBM is just about research and ignores individualization . If you read the ACPJC article, research is the last piece of the puzzle. Pt preferences and clinical circumstances come first.

What they are really arguing against is blindly following reaseach without considering the patient– and that is not want EBM is.

Our problem does not exist with EBM “experts”, however, many who “espouse” EBM do not understand it. This is the same problem that I have with the current guideline movement. Too many experts (or even drug companies) hide behind the terminology – but do not use the concepts properly.

I have received many positive comments from other colleagues over this piece, suggesting that many share my uneasiness with how the term EBM is often misused.

My colleague knows that I love precise semantics. I fear that EBM like guidelines no longer retains the precise definition. Linguists call this semantic drift.

So I trust my colleague to use EBM in the proper way. I must always question those who only understand the data and who do not understand the clinical context. I believe that he will agree that those physicians can cause harm.