It is more than 20 years since the evidence based medicine working group announced a “new paradigm” for teaching and practising clinical medicine. Tradition, anecdote, and theoretical reasoning from basic sciences would be replaced by evidence from high quality randomised controlled trials and observational studies, in combination with clinical expertise and the needs and wishes of patients. Evidence based medicine quickly became an energetic intellectual community committed to making clinical practice more scientific and empirically grounded and thereby achieving safer, more consistent, and more cost effective care. Achievements included establishing the Cochrane Collaboration to collate and summarise evidence from clinical trials; setting methodological and publication standards for primary and secondary research; building national and international infrastructures for developing and updating clinical practice guidelines; developing resources and courses for teaching critical appraisal; and building the knowledge base for implementation and knowledge translation.<\/p>\n
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Are Children Overmedicated?<\/a> [see fore·told…<\/a>]. So when I have an opinion, I try to say it up front in case you have a similar affliction. In this case, I’ve supplied an image to let you know how I feel about the notion of Evidence·Based·Medicine<\/font><\/strong>. I don’t like it. <\/p>\n
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- \nThe idea generalizes a small, short-term experiment on carefully selected subjects as a paradigm for large, heterogeneous group who may take the medication for years [as if such a transformation is scientifically justified – which it rarely is]. <\/font><\/div>\n<\/li>\n
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It is built on the phantasy that is similar to the notion that building a model airplane that flies is the last step before going into production for jumbo jets.<\/font><\/div>\n<\/li>\n- \n
It opens a portal for companies with only<\/u> conflicts of interest to easily insert their products into mainstream medicine effortlessly.<\/font><\/div>\n<\/li>\n- \n
following from number 2., it virtually guarantees corruption [as has been shown repeatedly in a variety of venues].<\/font><\/div>\n<\/li>\n- \n
While one motive of Evidence·Based·Medicine<\/strong> is to discourage sloppy "shooting from the hip," it replaces that with an even more dangerous sloppy dependence on rote and thoughtless practice.<\/font><\/div>\n<\/li>\n- \n
It has been regularly used to withhold services and treatment, denigrate anything subjective in medicine, and justify practices that are supported by trivial statistics rather than clinical effectiveness.<\/font><\/div>\n<\/li>\n- \n
It discourages the time honored method of evaluating medications by their performance in wide clinical practice.<\/font><\/div>\n<\/li>\n- \n
The people setting the guidelines have been not only often compromised, but also largely non-practitioners.<\/font><\/div>\n<\/li>\n- \n
It was itself an idealistic and naive experiment that failed its own clinical trial.<\/font><\/div>\n<\/li>\n<\/span><\/ol>\n
for starters… This article is by a group hoping to reform Evidence·Based·Medicine<\/font><\/strong><\/span> [the Evidence Based Medicine Renaissance Group] and I think they mean well. They want to restore clinical judgement, compassion, common sense to this concept that was instrumental in their loss in the first place. They conclude:<\/div>\n\n
Much progress has been made and lives have been saved through the systematic collation, synthesis, and application of high quality empirical evidence. However, evidence based medicine has not resolved the problems it set out to address [especially evidence biases and the hidden hand of vested interests], which have become subtler and harder to detect. Furthermore, contemporary healthcare’s complex economic, political, technological and commercial context has tended to steer the evidence based agenda towards populations, statistics, risk, and spurious certainty. Despite lip service to shared decision making, patients can be left confused and even tyrannised when their clinical management is inappropriately driven by algorithmic protocols, top-down directives and population targets.<\/div>\n<\/p>\n
Such problems have led some to argue for the rejection of evidence based medicine as a failed model. Instead we argue for a return to the movement’s founding principles — to individualise evidence and share decisions through meaningful conversations in the context of a humanistic and professional clinician-patient relationship. To deliver this agenda, evidence based medicine’s many stakeholders — patients, clinicians, educators, producers and publishers of evidence, policy makers, research funders, and researchers from a range of academic disciplines — must work together. Many of the ideas in this paper are not new, and a number of cross sector campaigns with similar goals have already begun. We hope that our call for a campaign for real evidence based medicine will open up debate and invite readers to contribute [for example, by posting rapid responses on bmj.com]. <\/div>\n<\/blockquote>\nAs for me, if I never hear the term again, that would be just fine. I think Clinical Trials are a first shot at eliminating inert and grossly unsafe medications from our pharmacopoeia – nothing more. Their centrality has been a disaster as explained eloquently by Dr. Healy in his book Pharmageddon<\/font><\/a>. The operative principle here is:<\/div>\nFool me once, shame on you.<\/font><\/em><\/div>\nFool me twice, shame on me.<\/font><\/em> <\/div>\n","protected":false},"excerpt":{"rendered":"Evidence based medicine: a movement in crisis? by Trisha Greenhalgh, Jeremy Howick, Neal Maskrey, for the Evidence Based Medicine Renaissance Group British Medical Journal. 2014 348:g3725 It is more than 20 years since the evidence based medicine working group announced a “new paradigm” for teaching and practising clinical medicine. Tradition, anecdote, and theoretical reasoning from […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-47363","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47363","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=47363"}],"version-history":[{"count":17,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47363\/revisions"}],"predecessor-version":[{"id":47380,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47363\/revisions\/47380"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=47363"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=47363"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=47363"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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