I love studies that examine the foundations on which so many people base their everyday decisions. These kinds of studies often draw into question those very same foundations. Like a man addicted to Jenga, I can’t help but to pull out one of those bottom sticks.
In this case, the foundation is one that doctors and many others use to argue for or against certain treatments — whether those treatments are “evidence-based.”
“Evidence-based” is the fuzzy, feel-good term doctors and others use to describe what it is they think they are doing, but in reality, rarely do. Some researchers, insurers and medical publishers turn to “evidence-based” medicine as the final quality arbiter for the usefulness of a procedure or treatment. “Is it evidence-based? What do the evidence-based guidelines say?”
Well, it would be a good thing if the “evidence-based guidelines” were themselves, umm, evidence-based, right? Like, you know, high quality data and research. That is, the guidelines should have logical, high-quality empirical data backing up their methodology, not just their findings.
Last month, PLoS Medicine published a study that examined just that issue and the findings shouldn’t be surprising:
[...T]he findings serve to warn clinicians that evidence-based guidelines are not necessarily based on high-quality evidence. In addition, they emphasize the need to make the evidence base underlying guideline recommendations more transparent by using an extended grading system like the CHEP scheme. If this were done, the researchers suggest, it would help clinicians apply guideline recommendations appropriately to their individual patients.
– PLoS Editors
Dooh!
So while it’s fine to throw out terms like “evidence-based medicine” as though it means something, be aware that such evidence may be of poor quality or flawed. The researchers in this particular study only examined one specific area (cardiovascular risk management), but it’s a biggie. If this large area of medicine can’t get things right, you’d better believe areas like “evidence-based depression treatments” are in little better shape.
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One Comment to
“How Evidence-Based Are the Recommendations in Evidence-Based Guidelines?”
I worked in New Hampshire in a Community Mental Health Center during the time of some research trials on the Dartmouth Evidence Based Practices so widely used today.
We had a very difficult time, as did another “research site” in the state getting familys to participate in the Family Psychoeducation EBP. Our familys were unwilling (and I think rightly so) to sign on for the extensive time committment required (at least a1 and 1/2 years from the start of the expected improvements).
Dartmouth and the Psychiatric Research Center blamed us for not being able to get families to agree to participate and eventually said they were just going to eliminate our data from the study results. What kind of evidence base is that? Why should they be trusted at all?
Internatinal Association of Psychiatric Rehabilitation Professionals recognised and recommended many years ago that there can be no one single model of services. Yet the States and Federal government tout the EBP’s as they service delivery of choice (because they are cheaper than individualized service delivery).
Remember that almost all of these practices move to group delivery from individualized service planning and delivery.
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Last reviewed: By John M. Grohol, Psy.D. on 18 Sep 2007
