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|Title: ||Why Evidence Based Medicine May Be Bad for You and Your Patients|
|Authors: ||Shaw, G.M.|
|Issue Date: ||2007|
|Citation: ||Shaw, G.M., Chase, J.G. (2007) Why Evidence Based Medicine May Be Bad for You and Your Patients. In V. Nayyar (Ed.). Critical Care Update 2006 (pp. 9-20). New Delhi: Jaypee Medical Publishers.|
|Abstract: ||Evidence based medicine (EBM) has inveigled itself into almost every aspect of
medical practice in the last decade (or more) with promises of better delivery of health
care and a more rational basis by which to deliver that care. Thus, an appropriate
question at this time might be: How does the evidence for the so-called “evidence” of
EBM stack up?
This review argues that the basis of EBM is so deeply flawed that in many cases it
cannot usefully inform clinical practice, reflected in fact by the current majority
outcome of most trials as “no-blood,” or no result. The illusion that knowledge can
be created using only empiric data from large randomised controlled trials (RCTs)
that test single hypotheses and draw conclusions from multi-variate regression
correlations is examined. Particular attention is paid to how this idea undermines the
advancement of in-depth, fact-based medical knowledge and, as a result, patient care.
The flawed logic behind the EBM rationale of treating risk, as determined by
probabilistic outcome measurements, means EBM will never be equipped to identify
individual benefit or harm. Thus, it can never usefully inform the attending clinician
about titrating therapy to the individual case. Hence, the results of EBM can never
improve a single patient’s care, only the averaged odds faced by that patient being
treated by a statistical outcome correlation based therapeutic choice, at best.
Finally, despite its emphasis on large trials utilising inherently flawed logic, EBM is
ruling the “mindshare” of medical and administrative thinking, precluding other lines
of thought and stifling scientific debate. Clinicians need to re-think how they gather,
interpret and act on evidence. and, in fact, what defines “evidence” outside the
definition of trial size, randomisation and blinding. Through its implicit emphasis on
treating risk, and not disease, EBM paradoxically risks much more.
The monotonous march of performing large RCTs, crunching the statistics and
presenting the results for the latest journal issue, has come to define medical research.
As a result, it has stifled the idea that reasoned evidence, based on the complementary
use of both hypothesis-based trials and logic-based reasoning has any contribution to
make in this brave new world. Forgetting of course that it was just such
complementary forms of research engagement that drove the last several hundred, if
not thousand, years of scientific and medical research – until now.
So, enter, if you will, this editorial on the state of the evidence, or lack thereof, in
medical research today. The authors claim no competing interests outside the biases
that they entered the room with.|
|Publisher: ||Jaypee Medical Publishers|
University of Canterbury. Mechanical Engineering.
|Description: ||Invited commentary and debate|
|Research Fields: ||Fields of Research::320000 Medical and Health Sciences::321000 Clinical Sciences|
Fields of Research::320000 Medical and Health Sciences::320500 Pharmacology and Pharmaceutical Sciences
Fields of Research::290000 Engineering and Technology::291500 Biomedical Engineering
|Rights URI: ||http://library.canterbury.ac.nz/ir/rights.shtml|
|Appears in Collections:||Chapters and Books|
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