Dr Amy Price
There are questions to ask when changing a name. A name is an expression of identity, culture, power and history. One question, who in Evidence Based Health Care, is ashamed of their roots? Not me, I am excited to be included where best evidence is considered the foundation for medicine.
Erasing History and Dishonoring our Founders
When we change a name we erase our history and subtract from our foundation. In building structure taking away from the foundation can destroy us and a name is what we are called and the cornerstone of our foundation. Changing the name of Evidence Based Health Care can lead us to a path of systems struggling for identity and position. This can engender confusion, strife and inward thinking that distracts from sharing the message that evidence is the foundation of medicine to a needy world struggling for direction.
Evidence Based Health Care Saves Lives
I am privileged to be a part of a young medical team in a low resource country. They have done the seemingly impossible and saved lives by finding the best evidence for their patient and applying it. We worked with consultants, medical students, social workers and patients to find a solution for a young woman with a tumor that disfigured her face and was robbing her of sight. There were not enough specialists and time was running out. Best evidence was fastidiously gathered and critically appraised. The evidence and risks were carefully explained to the patient and family. The doctor, the one anesthesiologist and the interns prepared, the medical students gave their own blood for the surgery. Based on best available evidence and with limited resources the patient was operated. The surgery took more than 8 hours but the patient made a full recovery. No one made any money or gained status bringing awards, it was just another day in a low resource country where the boundary between life and death was best available evidence. The recovery of the patient to all those that worked from gathering evidence to medical intervention was priceless.
Replacement without Reason for Evidence Based Health Care?
I am proud to belong in the sphere of evidence-based medicine and I like the name Evidence Based just as it is. To me this says consider the evidence so we have quality health care to give. Building on a foundation or base of evidence makes quality care and consideration of values more and not less likely. I applaud the approach of value driven medicine. I first learned about how important this is through my Masters at CEBM. Here values are structured as part of the fullness of medicine rather than as only an offshoot of patient opinion. In my experience Evidence Based Health Care deeply supports patient automomy, informed shared decision making and adds value. No need to change the name. We can add to the focus by supporting those within EBHC and welcoming others with expertise and enthusiasm who specialize in this area so that we can all grow in value consciousness skills together. I don’t appreciate evidence informed as a replacement because information without application or priority is a disaster in the making and is not medicine. In short Evidence Based is not something that is just either or Evidence Based embraces all and more.
There are many papers about research waste. Can we consider this in terms of a name change? Much labor and resources would have to go into rewriting everything and changing out materials. We would lose momentum and Google rankings and perhaps even public confidence.People become disorientated and unsettled. In the fast pace of medicine and all that we are working towards together can we afford this kind of distraction? Let us not discard the precious track record that the integrity of Evidence Based Medicine has fought for. Can we consider the effect filters that filter to every aspect of medicine and care. People from all disciplines on medicine, research, and science are joining us. We have Evidence Based Veterinary Medicine and Evidence-Based Mental Health. Are they to pay the price for a group who bows to outside criticism without respect for the foundation that brought evidence to medicine?
Critics are not Builders or Leaders
The flurry of papers attributing Evidence-Based Medicine to exclusive bias or error when these problems have existed since the beginning of medicine is harmful and it wrongfully communicates that these problems are an EBM problem. These papers send the message that there is no need to fix the rest of healthcare.
What has ripping apart Evidence Based Health Care under the guise of improving methodology done to help healthcare?
Instead of sharing with those who don’t know how to critically appraise a paper or find evidence I now need to gain their trust again after they read these things An amateur points to problems but an expert looks for ways to solve them and then gathers a team to do this. I suggest we give no place for the critics to determine our name or our destiny. If they have changes to make in medicine and healthcare let them name these and we will applaud them. Let them write papers for their innovations and let these stand on their own merits rather than siphoning citations by criticism without construction or resource building. When there are changes to make and things to fix we need to work on these rather than change a name.
Dr Amy Price is a D.Phil Student in Evidence Based Heath Care at the University of Oxford.