The Double-Edged Sword of the Evidence-Based Medicine Renaissance

JH1A meeting involving critics and proponents of Evidence-Based Medicine (EBM) took place in September 2013 to discuss how to overcome current problems with EBM. Led by Trish Greenhalgh, the meeting attendees wrote an editorial that was published last week in the BMJ. The article, “Evidence based medicine: a movement in crisis?” argues that the many benefits of EBM have too often been obscured by undesirable and often unintended consequences including:

 

  1. Misappropriation of EBM by vested interests. These interests are often commercial but also include managers who use guidelines to control practitioners. Ironically while these guidelines are touted as ‘evidence-based’ they often lack a sound evidence-base.
  2. An unmanageable volume of evidence being produced
  3. Statistically significant but clinically irrelevant benefits being exaggerated in large trials and systematic reviews that report relative rather than absolute effects.
  4. Evidence being produced that is unsuitable for clinical practice, where patients often present with a complex mix of psychological, physiological, and social problems as well as other comorbidities.

The BMJ editorial has been a real hit, with thousands of views and downloads, as well as over 30 rapid responses. There is clearly a thirst for a renewed and refreshed version of EBM that helps achieve EBM’s stated aims.

The success of the editorial, however, is a double-edged sword. Complementary and alternative practitioners like the editorial because they can use it to point out that conventional medicine is not based on (good) evidence. Commercial interests will use it to undermine evidence suggesting their treatments don’t work. And without Herculean efforts (that go far beyond writing a beautiful article) the tide of the growing number of publications will not be stemmed. Meanwhile, the central and simple message of EBM, namely that best research evidence needs to be combined with patient values and circumstances, along with practitioner expertise, threatens to get buried under a mass of nebulous and heterogeneous critique. This will take us further away, and not closer to out goal of using best evidence to improve patient care.

The success of the renaissance depends on setting up and acting on an agenda that reinstates the core values of EBM so that patients benefit. This is just one of the aims of the 2015 Evidence Live Conference. Our interests as clinicians, policy makers, researchers, and (potential) patients are at stake!

Jeremy Howick

About Jeremy Howick

Jeremy is a funded postdoctoral research fellow at the CEBM. Jeremy's research draws on his interdisciplinary training of science and clinical epidemiologist. Research interests include the nature of 'placebos' and whether their use is ethical in clinical practice and clinical trials, the role of 'mechanistic reasoning' as evidence for efficacy and effectiveness for medical and social policy interventions. CEBM and Postgraduate Programme in EBHC tutor, Jeremy is also the author of The Philosophy of Evidence-based Medicine.

View more posts by Jeremy Howick

3 comments on “The Double-Edged Sword of the Evidence-Based Medicine Renaissance

  1. I could not agree more. How can we work as a team to make an impact so that Evidence 2015 falls on fertile ground?

    I do not think that EBM is in crisis.

    I have lived through all the psycho-social and industry rhetoric, it is not substitute for Evidence Based Health Care and does not enrich it unless applied in a complementary manner

    The answer is simple, best evidence matters and that has not changed since the beginning.

    As a result of growing knowledge based on existing evidence the quality of evidence and its application to personal values will consider to soar.

    Quote from Sir Muir Grey
    The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade.

    Sir Muir Gray, ‘the future is imagined, planned and built’.

    Vision does not grow by imaging crisis it grows by seeing answers to and implementing them.

  2. EBM is truly in crisis because what is being practised as EBM today is only MBE (Medicinne Based Evidence ) which is empirical

Leave a Reply

Your email address will not be published. Required fields are marked *