The insistence on use of evidence in medicine is far more than just a buzzword. It refers to a comprehensive way of thinking about making medical decisions both for individual patients and for communities, nations, and various public health organizations. It attempts to ground decision making in scientific fact and statistics rather than simply common practice or intuition. It is especially favored in countries with some form of publicly-funded health care that are attempting to ensure that the policies and procedures they fund are actually effective rather than driven by bias, superstition, industry pressure, or habit.
History of Evidence-Based Medicine
In a sense, all medicine tries to base itself on evidence. Even in ancient Mesopotamia, doctors would attempt to observe the effects of different herbs or surgical practices on patients and write down and share observations. In the seventeenth- and eighteenth-centuries, practices such as dissection and microscopic observation allowed medical professionals to gather new types of scientific evidence to support new medical practices.
The term “evidence-based medicine,” however, is actually a product of the late 1980s, and in particular the work of David M. Eddy, who argued for the use of certain specific types of evidence as guidelines for insurance policies and clinical guidelines in a series of articles published in the Journal of the American Medical Association in the 1990s. The Evidence-based Medicine Working Group at McMaster University applied this concept to medical education and clinical practice in the 1990s and has continued its work through the present.
What Counts as Evidence
A key concept in assessing evidence is that of levels of evidence. In other words, working groups across the world have been trying to come up with a way of systematically evaluating what constitutes good or bad evidence for a certain practice, according to the National Institutes of Health.
For example, patients might want a certain medications or treatments because they saw ads for them on television or family members swore by them or they read about them on the Internet, but these are not adequate reasons for doctors making important patient-care decisions or insurance companies deciding which procedures or medications to fund. Instead, working groups have come up with a multi-level hierarchy that ranks types of evidence.
Although there are several different approaches depending on specific applications, types of evidence are generally ranked as follows:
- Large-scale high-quality randomized controlled trials
- Smaller randomized controlled trials with weaker results
- Cohort studies
- Case or case series studies
- Expert opinion, clincal example or bench research
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The Future of Evidence
As the population ages and medical care absorbs an increasing part of our GDP, the use of evidence in assessing the effectiveness of health care practices becomes an economic as well as public health issue. This is especially the case as research advances in genetically-tailored medicine and other new and extremely expensive therapies become increasingly common. While pharmaceutical companies stand to profit enormously from the introduction of new drugs and technologies, before countries or individuals invest heavily in such products, it is import to evaluate their safety and effectiveness on the basis of unbiased scientific evidence.