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.

Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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    Last reviewed: By John M. Grohol, Psy.D. on 18 Sep 2007
    Published on PsychCentral.com. All rights reserved.