Comments on: Evidence-Based Medicine: A Myth in the Making http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/ Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999. Tue, 14 Feb 2012 17:30:17 +0000 hourly 1 By: Jim Fairley http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/comment-page-1/#comment-563651 Jim Fairley Mon, 18 Aug 2008 20:22:47 +0000 http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/#comment-563651 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. 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.

]]> By: Eivind Eklund http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/comment-page-1/#comment-174261 Eivind Eklund Wed, 21 Feb 2007 13:51:43 +0000 http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/#comment-174261 _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. _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.

]]> By: _Sky http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/comment-page-1/#comment-25603 _Sky Wed, 31 May 2006 22:53:13 +0000 http://psychcentral.com/blog/archives/2006/05/30/evidence-based-medicine-a-myth-in-the-making/#comment-25603 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. 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.

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