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 for:
- individual patients
- 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. They are attempting to ensure that the policies and procedures they fund are actually effective rather than driven by:
- industry pressure
History of Evidence-Based Medicine
In a sense, all medicine tries to base itself on evidence. Even in ancient Mesopotamia, doctors attempted to observe the effects of different herbs or surgical practices on patients. They wrote down and shared observations. In the 17th and 18th centuries, practices such as dissection and microscopic observation enabled 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. He 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. It 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 around the world have been trying to come up with a way of systematically evaluating what constitutes good or bad evidence for a certain practice. This is 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 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, 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 expensive therapies become increasingly common. Pharmaceutical companies stand to profit enormously from the introduction of new drugs and technologies. However, 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.