The Ups and Downs of Evidence Based Medicine
In medicine the term evidence-based causes more arguments than you might expect and that’s quite apart from the recent political controversy over why certain words were avoided in CDC budget documents. The arguments don’t divide along predictable partisan lines either. Evidence-based medicine is the topic of this week’s Healthcare Triage. The mission of evidence-based medicine is surprisingly recent. Before its arrival much of medicine was based on clinical experience. Doctors tried to figure out what worked by trial and error and they passed their knowledge along to those who trained under them. Many were first introduced to evidence-based medicine through David Sackett’s handbook first published in 1997. The book taught me how to use test characteristics like sensitivity and specificity to interpret medical tests. It taught me how to understand absolute risk versus relative risk. It taught me the proper way to use statistics and diagnosis and treatment and in weighing benefits and harms. And hopefully I’ve used to teach all of you something about all of that over the years. It also firmly established in my mind the importance of randomized controlled trials and the great potential for meta-analysis which group individual trials for greater impact. This influence is apparent in what we do here at Healthcare Triage. But evidence-based medicine is often described quite differently. Everyone’s a bit right here, and everyone’s a bit wrong. This battle is not new; it’s been going on for some time. It’s the old guard versus the new. It’s the patient versus the system. It’s freedom versus rationing It’s even the individual physician versus the proclamations of the specialized elite. Further, too often we treat all evidence as if it’s equivalent. I’ve lost track of the number of times I’ve been told – even by many of you – that “research” proves I’m wrong. All research is not the same. A hierarchy of quality exists, and we have to be sure not to overreach. Finally, we have to recognize that … Years ago, Trisha Greenhalgh and colleagues wrote an article in the BMJ citing evidence-based medicine as “a movement in crisis” It argued that we’ve moved too much from focusing on disease to risk. This point, more than any other, highlights the problem evidence-based medicine seems to have in the public sphere. If evidence-based medicine is to live up to its potential, it seems the focus should be on THAT side of the equation as well instead of taking best guesses and calling them evidence-based. That, probably more than anything else, has made the term so widely mistrusted. We love to make videos about things that sometimes YouTube doesn’t like to sell to advertisers. And we’re fine with that because what we do is more important than the money we might make. That said, any support you can give us to help keep the show going helps to make it bigger and better. And one good way to do that is through a subscription service called patreon.com. You can go to patreon.com/healthcaretriage and give as little as $1 a month to help the show keep going. If you don’t that’s fine. We’re gonna keep on making it anyway. We’d also appreciate if you subscribe to the show maybe like the video if you liked it. That’d be great too. We’d especially like to thank our Surgeon Admiral Sam and our research associates Joe Sevits and Carlos Callirgos. We also have some great merch you might like. We have mugs and posters and lunch boxes and other stuff and you can check it all out at HCTMerch.com. I also have my book. It’s still available anywhere books are sold: “The Bad Food Bible.” I’d really appreciate if you pick up a copy.