Evidence-Based Medicine: What’s in a name?

Understanding what Evidence-Based Medicine is remains crucial to its application to improving patient care.  


In 1992 the Evidence-Based Medicine Working Group reported in JAMA : ‘Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research.’CHindex

Because of the prominence given to ‘de-emphasizing’, I find this definition somewhat unhelpful. For instance, the article reports: the development of clinical instincts (particularly with respect to diagnosis) are a crucial and necessary part of becoming a competent physician, which is at odds with reducing the importance of intuition.

In 1996, the BMJ published a lead editorial by Dave Sackett on Evidence-Based Medicine: what it is and what it isn’t. Outlining the definition of EBM as: ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.’

By stressing the important components of EBM it became clearer that evidence, values and expertise have similar roles to play in overall clinical decision making. However, a number of definitions have, unhelpfully, gone onto emphasize the use of evidence alone for decision making:

E.g., Wikipedia, Dec 9th, 2009: ‘Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well designed and conducted research.’

Moreover, Evidence-based has become a term used so widely  – 96 500 000 results on google – you can find it in all sorts of areas. From insurance companies, to management  and even a journal for evidence based design! Therefore, although decisions can be based on evidence, it cannot necessarily be evidence-based. Mainly, as I am not sure what is meant by the term, particularly when it turns up as ‘evidence-based recommendations’ and  given  it used so widely. However, the good news is that decision making based on evidence is hard wired into society –  not the case 20 years ago.

One problem, though, with the definition of EBM is its restriction to clinicians. Evidence-Based Health Care (take a look in the Centre’s 1996 prospectus)  is about extending the principles, strategies, and tactics of evidence-based decision-making to other health professionals, to public health practitioners, to health planners and purchasers, to health policy makers, to health administrators and managers, and to consumers. Basically…….everyone.

However, what the definition of EBM does not encompass, is all those who contribute to EBM through the undertaking of research and teaching. This is important, as current problems with the evidence-base (note this is not the same as evidence-based) are substantial, and limiting its use and application to patient care. Why we have Theme 1 of the EvidenceLive conferenceImproving the Quality of Research Evidence

Therefore, I have added one word to the current definition. Aiming to encompass all those who contribute through the development of high quality evidence to use in individual patients.

The conscientious, explicit, and judicious development and use of current best evidence in making decisions about the care of individual patients.

What’s in a name? Quite a lot when you think about it.

 

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Theme 1: Improving the Quality of Research Evidence

Shifting the paradigm for the “E” in EBM discusses what can be done to address the problem biases, which may distort the design, execution, analysis and interpretation of research to better support evidence-based practice.

Abstracts are sought that focus on:
• Current conduct of trials – shortfalls and methods for improvement.
• Publication bias, withholding of results and how barriers to access might be overcome.
• Problems around scientific integrity and conflicts of interest and solutions to reduce them.
• Focus on biases which may distort the design, execution, analysis and interpretation of research.

Carl Heneghan

About Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings and also blogs on Trust The Evidence at www.carlheneghan.com

View more posts by Carl Heneghan

5 comments on “Evidence-Based Medicine: What’s in a name?

  1. Nick Myles (Makretsov)

    Timely post. Teaching EBM should become a main focus since comprehension of EBM working elements does not come up naturally through medical schools curricula yet..You will be surprised that many nursing programs are already way ahead of medical schools in teaching EBM core concepts.

    Just one example of a very common misunderstanding:

    How many times I hear at the clinical rounds someone with strong voice is saying: we are not interested in probabilities and they are useless, because for our patients it is either “going to happen” or “not going to happen”, therefore it is always “1” or “0”. I then take some oxygen and try to explain what’s the matter: is there any difference between your expectation (=probability) and result of your expectation (=outcome)… Endless dispute between deterministic and probabilistic reasoning.

  2. IMHO, the name EBM matches with only a half of your definition. I dream of the day when the name will change and include patients values / indivivuality

  3. After I initially commented I seem to have clicked the -Notify me
    when new comments are added- checkbox and from now on every time a comment is added I get four emails with
    the exact same comment. Is there a means you
    can remove me from that service? Many thanks!

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