Last weekend I picked up the New York Review of Books, and was pleased to discover that Dr. Jerome Groopman offers a contrarian take on evidence-based medicine.
EBM guides health professionals to use the best evidence and not to rely on intuition and what they've always done before. This makes great sense. But the problem is that the "evidence" often comes in the form of consensus papers and guidelines that are necessarily generic, and often not applicable to the needs of real-life patients. This is especially true if the patients a doctor encounters are not demographically similar to the patients in clinical trials; Groopman speaks of "cherry-picking" study patients in such a way that the trials are easy to administer.
None of this means EBM is awful, just that it's not an unalloyed good. Librarians often teach about how to search EBM resources, and about the importance of critical thinking in general. We should ensure that students and practitioners critically think about the benefits and costs of EBM as well.
consensus papers do not count as "evidence" - and evidence-based patient care of course does include the adaption to the individual patient, his/her needs and wishes.
This cirtique on EbM is old and refuted for a long time, so let's talk about something interesting!
Posted by: Martin | November 30, 2009 at 02:22 AM