BusinessWeek had a wonderful cover article last week about the myth of evidence-based medicine, as Dr. David Eddy has spent a career in illustrating to other doctors and anybody else who will listen. As noted below, somewhere in the range of 20-25% of our medicine practices are evidence-based — that is, there is strong objective research evidence to support a particular treatment or intervention for a particular medical problem or disease. Most of what doctors do is based upon their own clinical judgment — judgment, which is often based upon conventional wisdom (”This is just how we’ve always treated this problem”), which is often just plain wrong.
He proved that doctors had little clue about the success rate of procedures such as surgery for enlarged prostates. He traced one common practice — preventing women from giving birth vaginally if they had previously had a cesarean — to the recommendation of one lone doctor. Indeed, when he began taking on medicine’s sacred cows, Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.
A great many doctors and health-care quality experts have come to endorse Eddy’s critique. And while there has been progress in recent years, most of these physicians say the portion of medicine that has been proven effective is still outrageously low — in the range of 20% to 25%. “We don’t have the evidence [that treatments work], and we are not investing very much in getting the evidence,” says Dr. Stephen C. Schoenbaum, executive vice-president of the Commonwealth Fund and former president of Harvard Pilgrim Health Care Inc.
It’s an interesting article and definitely worth a read. It gives people another reminder as to why it pays to become an informed and educated patient — because doing so leads to empowered patients who make better-informed decisions about their own health, rather than relying on the doctor’s judgment alone.
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3 Comments to
“Evidence-Based Medicine: A Myth in the Making”
Interesting subject indeed. I was recently involved in a short discussion about how sometimes just sitting with someone, being in the same office and sharing time, was therapeutic! That’s contrary to the evidenced-based medicine, imo.
_Sky, that’s actually fairly much inside what we’d expect from the scientific evidence. The problem is that too many people have little knowledge of the evidence, and that doctors and psychologists aren’t really trained well enough in how to read science (IMO).
Eivind.
Apologies for such a late contribution but only just came across this discussion today.
The whole EBM bandwagon has been hijacked in the cause of healthcare rationing. Psychology is certainly not alone in lacking RCT based evidence. Surgery has also very little evidence base, if by that you mean RCT’s. Common reasons for the lack of RCT’s include
* The benefit of treatment is obvious
* There are difficulties in defining outcome measures
* There are difficulties controlling for surgical skill/preference
* Techniques are continuously evolving
These constitute some of the more significant inherent limitations in the methodology used to produce “robust and reliable evidence”.
Inherent limitations in conducting surgical trials are not prominently acknowledged in Cochrane Reviews. The search methodology, and the standards used to select or reject trials from inclusion in the review, are of course prominently featured, but little is said as to
* why there may be a dearth of acceptable evidence, and
* whether the required RCTs are ever likely to be done.
Until recently, this didn’t matter much, because the reviews were likely to be read by interested and informed professionals only. Now, however, Summaries & Conclusions are now easily available on-line to healthcare commissioners and the general public. “No evidence of benefit” is being misinterpreted as “this treatment does not work”. Evidence based commissioning of health services is shifting funding away from treatments which lack the “evidence based” imprimatur. This has serious health implications. Not only could effective surgical treatments be denied to those who need them, but the stepwise evolutionary development of surgical techniques (mainly resulting from the application of technological advances) risks being strangulated by regulatory and funding requirements to show evidence of effectiveness at each stage.
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Last reviewed: By John M. Grohol, Psy.D. on 30 May 2006
