Why you should find evidence-based medicine to be intriguing
October 29. 2020
Bloodletting was a common medical treatment for centuries, but that is no longer the case. Eating citrus fruit was reported to be the cure for scurvy in 1747, and that finding is still valid today.
What is the difference between bloodletting versus eating citrus as time-tested therapies? The cure for scurvy was identified under controlled research conditions, and bloodletting was opinion-based therapy. The cure for scurvy is an example of evidence-based medicine (EBM).
Evidence-based medicine is not a sexy name that will be the hot topic in your office. However, use of EBM-approaches is key to identifying outcomes that will stand the test of time and support the value of your product or service.
A methodical approach to EBM is based on five steps:
- Formulating an answerable question, such as odds of being cured or accuracy of a diagnostic test.
- Systematically retrieving the best evidence available through peer-reviewed literature searches or other means.
- Critically evaluating the data that you obtain for its relevance to a particular situation and the quality of the data.
- Applying the results of the literature search in a real-world setting.
- Critically evaluating the real-world outcomes where EBM data is used.
Delving deeper into the critical evaluation of available information, there is the need to remember that case reports and editorials provide the lowest levels of evidence, whereas randomized controlled trials provide the greatest levels of confidence in the results. More refined evaluations of research studies will look at what stage(s) of disease is(are) evaluated, methods, details regarding study populations, and other potential sources of bias.
But what if original research studies have differing conclusions? What do EBM practitioners do then? While there is methodology to address these situations in clinical settings, systematic reviews and meta-analyses are the ideal solution. Note that narrative reviews are different than systematic reviews; systematic reviews follow a structure that maximizes balance and minimizes subjective biases. The potential for subjective bias is also reduced somewhat by methods for meta-analyses, where the results from multiple studies can be combined.
In addition to the science, evidence-based medicine incorporates clinical judgment and patient values:
- Clinical judgment: Clinician’s experience and knowledge of patients, their background, and the community are important parts of the process. This is because not all treatments and medical tests are appropriate for all people, and you’ll need to communicate effectively with clinicians to obtain their buy-in for your product or service.
- Patient values: This means that even if the evidence suggests that one course of treatment is “best” for extending the patient’s life, the patient has the option to pick another course based on their perception of side-effects, financial concerns, or other reasons. Therefore, as with clinicians, evidence-based medicine can serve as a foundation for effectively communicating with patients.
Where science, clinical judgement, and patient values overlap is a sweet spot where evidence-based medicine exists. This is where you want to be for developing medical treatments and diagnostic tests, as well as when you are communicating about your offerings.