Do you always practise Evidence Based Medicine?
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Evidence 2013
Do you always practise Evidence Based Medicine?
For everyone with an interest in evidence-based healthcare
Where does EBM fit with intuition, common sense and experience? Complete the poll and have your say. You can also find out more about EBM at the Evidence 2011 conference and website www.evidence2011.
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Forums » BMJ » Evidence 2013 » Do you always practise Evidence Based Medicine?
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Do you always practise Evidence Based Medicine?
posted at 7/9/2011 11:27 AM BST
on bmj.com
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Posts: 21
First: 11/12/2008 Last: 27/6/2012 |
Where does EBM fit with intuition, common sense and experience? Complete the poll and have your say. |
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Re: Do you always practise Evidence Based Medicine?
posted at 7/9/2011 4:34 PM BST
on bmj.com
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*Moderator*
Posts: 1436
First: 7/4/2011 Last: 17/5/2013 |
Response from Twitter:  jcmoralesr juan morales ruiz @doc2doc No. Medicine is an individual approach from a scientific frame. BME is a part of this frame. |
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Re: Do you always practise Evidence Based Medicine?
posted at 7/9/2011 5:36 PM BST
on bmj.com
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Posts: 1345
First: 25/1/2009 Last: 16/5/2013 |
EBM is great for some treatments - for others there is conflicting evidence or limited information and you find yourself straying to the realms of personal experience and advice from colleagues. |
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Re: Do you always practise Evidence Based Medicine?
posted at 7/9/2011 7:09 PM BST
on bmj.com
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Posts: 492
First: 12/7/2010 Last: 7/5/2013 |
I think we should always follow EBM. We should make use of what ever evidence available recognizing their caveats, if RCTs are not available, we can use observational studies, if those are not available we can use evidence from basic sciences. I don't think experience based medicine will be much good, there is too much potential for bias. Advice from colleagues or teachers if evidence based is always good but all the risks of bias arise if the advice is from experience. |
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Re: Do you always practise Evidence Based Medicine?
posted at 8/9/2011 10:58 PM BST
on bmj.com
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Posts: 116
First: 14/9/2010 Last: 7/2/2012 |
Agree with Joey- it depends on the quality of the evidence. Sometimes it isn't there and then what do you do? Even NICE accepts expert opinion is a form of evidence. But people mean different things by evidence and certainly you should start with Cochrane reviews but these will only answer a small number of questions and maybe not in your patients because trials are so selective that you will be hard pushed to find people like our patients who have co morbidities. Then the evidence often doesn't contain enough information to tell you how to do it. No doctors likes to practice cook book medicine as early opponents of EBM used to call it but as a patient I would want to know my doctor was up to date and careful. EBM Is great when it is there but it is limited in its relevance and scope still.However who is going to say they practice non evidence based medicine? |
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Re: Do you always practise Evidence Based Medicine?
posted at 12/9/2011 6:36 AM BST
on bmj.com
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Posts: 83
First: 20/5/2010 Last: 1/4/2013 |
In Response to Re: Do you always practise Evidence Based Medicine?: EBM is great for some treatments - for others there is conflicting evidence or limited information and you find yourself straying to the realms of personal experience and advice from colleagues. Posted by DrS This is EBM. Remember the hierarchy of evidence? If there are no good systematic reviews /> we try for RCTS - none of them > we try for other controlled clinical trials - none of them > we try for observational studies - none of them > we go with case studies and personal experience. EBM is made up of the three pillars of (i) evidence, (ii) clinical expertise, (iii) and patient's views. References http://www.bmj.com/content/312/7023/71.full http://www.theglobeandmail.com/life/health/when-we-began-we-were-almost-pariahs/article1344833/ |
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Re: Do you always practise Evidence Based Medicine?
posted at 13/9/2011 3:02 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
I think that so called "Evidence-Based Medicine" is not that simple as algoritms. Nowadays it is corrupted by the so called "Medical Industry Power" (Run by the industry of devices and drug companies) that drive the "business model" of healthcare. What to say about all these short-term randomized clinical trials and non-inferiority clinical trials, many times based on numbers and surrogate end-points, or "combined end-points" for the benefit of the big pharma´s new drugs for common&complex diseases? What to say about the deterministic (better called as simplistic or reductionist) medical approach to diseases instead of looking to the complexity of that one sick individual? Nowadays it is a must doing critical analysis of the the so-called "available evidence". And to make a long story short: "Absence of Evidence is not always Evidence of Absence" All Best, Joey
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Re: Do you always practise Evidence Based Medicine?
posted at 15/9/2011 9:05 PM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
One very common trap with nowadays evidence-based medicine is called "combined end-points" So, oranges and apples are combined to increase the power to reach statistical significance in order to favour the interests of the industry (device and drugs) in a randomized clinical trial. Is this real world or high quality evidence? All Best, Joey |
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Re: Do you always practise Evidence Based Medicine?
posted at 17/9/2011 8:20 PM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Another at least "strange" issue with some clinical trials happen when patients that are less likely to respond to a certain treatment strategy or to a new drug are just excluded. in the highly publicised ACCORD type 2 diabetes clinical trial for high cardiovascular risk diabetics, the following patients were excluded: Older than 79 years, Chronic Kidney Disease above stage 2, proteinuria higher than 1.0 gram/day, severely hypertensives, and severely dyslipidemics. And even with a short follow-up it was concluded that intensive blood pressure control is not worthy neither for cardiovascular outcomes (a "combined end-point"), neither for progression of retinopathy. But intensive BP control was good for fatal and non-fatal Stroke prevention (in this trial just a "secondary outcome"). Would you agree or apply to your clinical practice these conclusions? All Best, Joey |
Forums » BMJ » Evidence 2013 » Do you always practise Evidence Based Medicine?
