Philosophy Of Evidence Based Medicine Flashcards
definition of evidence based medicine
evidence based medicine de-empahsised intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficienct grounds for clinical decision making ad stresses the examination from clinical research
(JAMA reported upon it as a ‘new paradigm’ in 1992)
what is the hierarchy of evidence?
systematic reviews > RCT > observational studies > expert judgement
why is EBM important?
expert opinion found in textbooks disagrees with the results of high quality meta-analyses
there is an inverse relationship between quality of care and clinical experience - mechanical rules outperform expert judgement by 10%
example: 1972 papaer on computer aided diagnosis of acute abdominal pain, computer system accuracy was 91.8% compared to a senior clinician at 79.2%
what are the problems with EBM?
there is no evidence that EMB has done more good than harm
EMB has been ‘hijacked’ be vested interests - e.g. drug companies, ‘big pharma’, people who want their results to suit them and rig their trails accordingly. this includes financial conflicts of interest. evidence that everything for the way the research questions are worded to how evidence is produced can be influenced by nefarious individuals.
it denies clinicians use of intuition. even if EBM is better than clinician expertise, this does not mean that expertise is not useful.
it is missing the subjective experience of the patient and ho they found eh treatment - e.g. the patient might live 9 months longer but have a lower quality of life.
EMB evidence applies across a population and not to individuals. patient values and circumstances are ‘officially’ recognisedly EBM, but often this information is withheld form clinicians and researchers interpreting the data later.
questions regarding EBM
can we apply the results of trials to individuals?
- if so, why? if not, why not? is this linked to the problem of induction? if so, is it unsolvable?
has EBM done more good than harm?
