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[B Evidence-based medicine has been defined by its proponents as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. In this definition, the practice of evidence-based medicine means integrating individual clinical expertise with a critical appraisal of the best available external clinical evidence from systematic research. By individual clinical expertise is meant the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence is meant clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic factors, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.[/B] The practice of evidence-based medicine is a process of lifelong, self-directed learning in which caring for one's own patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues, and in which its practitioners:
1. Convert these information needs into answerable questions. 2. Track down, with maximum efficiency, the best evidence with which to answer them (and making increasing use of secondary sources of the best evidence). Examples of such secondary sources are the Cochrane Library and journals of critically appraised clinical articles such as ACP Journal Club and Evidence-Based Medicine. 3. Critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability). 4. Integrate the appraisal with clinical expertise and apply the results in clinical practice. 5. Evaluate one's own performance.
The rest of the article (probably behind paywall) is here: Evidence-based Medicine - Encyclopedia of Biostatistics - Sackett - Wiley Online Library
Nothing about quadruple-blind peer-reviewed studies conducted in the darkest recesses of pharmaceutical company basements here. Rather than erecting a bogeyman, I think it's important to know what evidence based medicine actually is. |
Thanks Phil for posting this more complete definition of what is meant by evidence based medicine. It is interesting to take note of the fact that clinical personal experience is highly factored into an evidenced based approach. There is nothing in the above definition that precludes naturopathic or homeopathic doctors from practising an evidence based approach. With the glaring exception of the fact that the body of scientific studies for herbal remedies (of one nature or another has not been built).
In my reading of the article below this person was not providing a definition of Evidence Based Veterinary Medicine in its totality - but as asserted in the first paragragh speaking to a specific question that they get quite commonly - ergo - where are the studies backing up your claims? And I have no doubt that is a question they often get! Certainly one I would ask. I believe it is a common conception (perhaps misconception) that there are scientific studies in traditional medicine to back up every treatment plan a vet or an MD makes. This article is pointing out the fact that this is patently not so. Is this assertion valid? IDK. But common sense tells me it is so. The author focussed on mechanism of action being unknown for many drugs out there. Is this a true statement of fact? IDK - How important is it to know the mechanism of action before prescribing a drug? Marketing it? Or is it more important to know that it works on some of the ppl some of the time - and if over time it is shown to be ineffective for condition a/b/c then you stop prescribing it. I have a question for you Phil - I have heard recently that Canada and the USA signed an international agreement years ago - 15 or more years ago - signed an accord that said - the funders of the research *own the research* - and that includes publishing or not the results of the study. As of yet I have not been able to confirm that assertion. If true that is very disturbing to me.
Homeopathic medicine has a huge body of clinical experience available to the doctors of said medicine. At least that is my understanding.
I how-ever agree that this article whilst pointing out some of the short-comings of Western medicine does nothing to advance the validity of homeopathic or naturopathic discipline. Evidence Based Veterinary Medicine
Many of our posts, articles and authors seem to irritate vets and pet owners who are firmly entrenched in traditional medicine. By and large, the most common challenge they use against us is,
“where are the scientific studies backing up your claims?”
It’s paradoxical that holistic medicine is unfairly held to a higher burden of proof than mainstream medicine. Do the vets and pet owners who accuse us of promoting medicine that lacks ‘scientific validity’ know that the majority of conventional drugs have an unknown mechanism of action?
One Golden Example
Some interesting examples from conventional human medicine include the 1950’s use of tetracycline (an antibiotic) in the treatment of rheumatoid arthritis
on the theory that it was caused by infectious agents. This was discontinued when rheumatoid arthritis came to be thought of as an autoimmune disease and the standard treatment changed to gold compounds despite
their mechanism of action being largely unknown.
The mechanism of action for acetylsalicylic acid, a compound found naturally in white willow bark, and better known as Aspirin, was not discovered until 1971, although it had been available commercially and prescribed since about 1899.
The mechanism of action is in fact unknown for large numbers of commonly prescribed drugs including statins, most psychotropic /psychiatric drugs like Lithium, acetaminophen and Lysodren (a common chemotherapy drug) and general anaesthetics. Would it then make sense to stop using those on surgical patients?
And this is by no means a comprehensive list.
It’s very common in the pharmaceutical industry for drugs to be in vogue for a particular condition, for a certain period of time and to later be found as useless, ineffective, dangerous, or more useful for some other condition than for which they were created.
Ironically, we don’t have that problem with homeopathic remedies or medicinal herbs. The same ones that worked 200 years ago still work today. On the same conditions.
Sadly, “evidence based medicine”, although an excellent concept, has been corrupted into a buzzword used to discredit the results of raw feeding, homeopathy and other so-called alternative health care methods. “Evidence based” means that data from randomized controlled studies provides certainty about whether a treatment will work and is safe. The reality is 66% of the treatment procedures and drugs that are commonly used in conventional medicine have no or little evidence to recommend them (British Medical Journal, 2007). Many procedures have serious complications and many drugs cause difficult and unwanted effects. It is these issues that drive pet owners toward less harmful and health promoting approaches in the first place.
Below is the breakdown of clinical evidence for 2,500 common medical treatments from the study in the British Medical Journal.*
{{{
SEE CHART ATTACHED BELOW }}}
That’s a big grey area on the left, isn’t it? Add “unlikely,” “likely to be ineffective or harmful,” and “trade-off,” and that’s
two-thirds of conventional medical treatments that are dubious.
The situation is likely worse in animal medicine. Often, human drugs and medications that have failed human trials are subsequently solicited to the pet market. In addition, there is no formal requirement for reporting adverse reactions to pharmaceuticals in veterinary medicine.
The next time somebody defends conventional medicine by asking us for “scientific validity”, we might ask them the same question.
Thanks Ann for posting this article - although finding the links were tough.