Evidence Based Medicine

Defining Buzzwords

“Evidence based medicine” may be one of the latest buzzwords in both natural health and mainstream medicine, but for all of its hype, it is rarely found–in either model of healthcare.

“Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients.” – Masic et al, 2008 Despite seeming rather straightforward, the integration of the best available evidence is a rather complex and difficult task for care providers of both holistic and mainstream models of care.

EBM vs Traditional Medicine?

One common misconception is that “evidence based medicine” is an alternate term for “accepted medical practice” or even “modern medicine.” This approach implies that traditional medicinal models, such as the use of herbalism, are then in direct contrast with evidence based medicine. Such a misconception needlessly complicates the practice and creates a false dichotomy.

Both traditional models and modern models rely on evidence. The distinction is the quality and weight of the evidence utilized. An evidence based model rejects poor evidence in favor of stronger evidence. In plain language, an evidence based model means nothing more than: basing medical decisions on what actually works.

Applying that simple definition, many traditional practices fail to meet the standards of evidence based medicine not because it exists in opposition to natural health, but because many practices in natural health are unable to produce evidence substantiating that they actually work. There are numerous reasons these practices appear to work, ranging from misunderstanding the natural history of disease to the placebo effect. But when tested in a controlled environment that removes the placebo effect and the potential for other explanatory factors, many of these beloved treatments are found to be ineffective.

But isn’t modern medicine also flawed?

Absolutely. The same can be said of commonly accepted medical practices. Both natural health and mainstream medicine are guilty of embracing practices, protocols, and habits that are in direct conflict with scientific evidence. Using the best available evidence often means refusing commonly embraced mainstream medical practices as well.

One reason both systems are flawed is the success of marketing firms in both fields. The multi-billion dollar natural products industry is frequently found guilty of using unsubstantiated marketing claims. Similarly, the even larger pharmaceutical industry has achieved substantial growth by marketing treatments directly to patients and providers.

Another significant reason conventional medicinal practices fail to match the evidence is that the decision makers are rarely qualified to interpret scientific evidence. Many health related policies are determined by politicians, who are often trained in the law or political science. These policies are often determined by what the politician perceives their voters prefer or what lobbyists have convinced them to support rather than what is in the actual best interest of the population. Hospital and individual policies are also determined by insurance company norms of coverage, which are established by a cost-benefit analysis rather than an evidence-based practice. And even in private practice, policies and protocols are often influenced by not only insurance coverage, but confirmation bias, personal experience, financial interests, and opportunity rather than scientific evidence.

A final contributing factor is the tendency of both patients and providers to rely on confirmation bias rather than the entirety of the scientific literature. Merely finding a study or two to support a previously held belief does not necessarily reflect the entire body of knowledge. This is further complicated by the advancement of research methodology, which is a separate and distinct skill from practicing medicine. Many medical providers, both conventional and traditional, have minimal training in epidemiology, statistics, and research evaluation. Communication between the researchers who work behind the scenes and the providers who put these findings into action is severely lacking.

So how do you make decisions based on the evidence?

An evidence based model demands a continuous supply of better and higher quality evidence in addition to the openness and willingness of practitioners to change and update protocols when evidence requires. This doesn’t mean updating protocols or changing norms each time a study is released. A truly evidence based model is not based on cherry picked abstracts or citations. A truly evidence based model reflects the entirety of the existing evidence, often only achieved through advanced research interpretation and the availability of higher tiers of evidence such as meta-analysis.

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