What Is Evidence Based Medicine?

               The current news spin often mentions something called evidence based medicine, treating it as somewhat of an idol to follow in the medical world.   One might ask why anyone would do anything but follow “evidence” in caring for their health or in caring for a patient’s health.  Accusing someone of going against such medical wisdom gets one labeled with a variety of derogatory names.  While the case seems closed, it is not quite that simple, as is often the case.

               Evidence based medicine has a technical meaning.  In the medical world, it actually means basing one’s medical decision on the accumulated results of one or more studies.  These studies should have been conducted in a systematic and logical manner such that a therapy or test can be determined as effective or ineffective with some measure of certainty.  Such studies are needed to sort between therapies that are not effective, ones that are only mildly effective, and ones that are quite effective. 

               You might think that we can just know this from trying a therapy in the local medical office and  knowing whether the patient got better or not.  In reality, while such clinical experience is very important and helpful, multiple doctors treating single patients without a cooperative and systematic approach results in less definitive answers.  Rarely does one doctor know what the other is doing or seeing in terms of results.  Differences in doses might affect the outcomes.  Several different biases might make the results look better or worse.  The placebo effect can make something look better than it really is.  The list of problems goes on.

               With evidence-based medicine, most of these difficulties can be cleared away so that medicine as a whole can better determine if a treatment is effective or not.  I say most, because even with a system of research, even evidence-based medicine can be wrong.  The research study can be poorly designed such that it hides a true answer or even distorts the truth.  Furthermore, given that fallen scientists conduct these experimental studies, sometimes they intentionally fudge numbers to get the results they want.  At times, there is no way to design a study to answer the question one wants due to ethical or technical limitations. 

               In conclusion, evidence-based medicine should neither be an idol dictating medical practice nor blamed for being a conspiracy of deceit by greedy Big Medicine.  The evidence it provides should be examined for its validity and used as appropriate when it fits the situation.  Recognize and use it as a tool towards better health decisions as we seek optimal health in the 2020’s and beyond.