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Evidence based medicine: a movement in crisis?

Evidence based medicine: a movement in crisis?

An essay by Trisha Greenhalgh of Barts and the London School of Medicine and Dentistry, London and her colleagues and members of the Evidence Based Medicine Renaissance Group, was published last June in the British Medical Journal claiming that there's a crisis in Evidence Based Medicine. This movment, in which "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." started over 20 years ago and has had many successes.

The problems Evidence Based Medicine is currently facing are summarised as follows:


- The evidence based “quality mark” has been misappropriated by vested interests

- The volume of evidence, especially clinical guidelines, has become unmanageable

- Statistically significant benefits may be marginal in clinical practice

- Inflexible rules and technology driven prompts may produce care that is management

driven rather than patient centred

- Evidence based guidelines often map poorly to complex multimorbidity


I'm sure we'd all like to see more of Real evidence based medicine which:


- Makes the ethical care of the patient its top priority

- Demands individualised evidence in a format that clinicians and patients can understand

- Is characterised by expert judgment rather than mechanical rule following

- Shares decisions with patients through meaningful conversations

- Builds on a strong clinician-patient relationship and the human aspects of care

- Applies these principles at community level for evidence based public health


David Glance, Director of Innovation, Faculty of Arts, Director of Centre for Software Practice at University of Western Australia, argues that we need data and technology to fix the second problem:

"Large data sets providing detailed monitoring of patients combined with genetic information will eventually be able to reveal specific information about what makes a treatment work in one patient and not another."


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