Views
2 years ago

THE EVIDENCE FOR EVIDENCE-BASED MEDICINE Robert H ...

THE EVIDENCE FOR EVIDENCE-BASED MEDICINE Robert H ...

THE EVIDENCE FOR EVIDENCE-BASED MEDICINE Robert H

CommentaryTHE EVIDENCE FOR EVIDENCE-BASED MEDICINERobert H. Imrie and David W. RameyAbstract. In recent years the claim that only 20% or lessof standard Western medicine is evidence-based hasbeen repeated widely by health professionals and others. 1This assertion is perhaps most often made by proponentsof unproven (“alternative” and “complementary”) therapieswith the implication that, if true, it mightsomehow justify the integration of any number of unconventionalmodalities with a similar dearth of supportingscientific evidence into mainstream medicalpractice. It should be immediately noted that this line ofreasoning is an example of the logical fallacy tu quoque(“you did it too”): One party cannot criticize another becauseboth parties are guilty of the same “sin.” While thisargument may be without merit, it is often made andwidely held to be valid. Therefore, the authors of thispaper have attempted to identify the sources of, and examinethe evidence for, the “20% or less” claim. Theyalso document the investigations into real-world use ofmethods established through clinical trials and “evidence-based”medicine (EBM), and find that such investigationsestablish the evidence basis for methods inuse in modern medicine.Robert H. Imrie, DVM, is is a companion animal practitioner in private practicein Seattle, Washington. E-mail: aleonis@seanet.comDavid W. Ramey, DVM, is an equine practitioner in private practice in Glendale,California. E-mail: ponydoc@pacbell.netReprinted with permission from Complementary Therapies in Medicine.2000;8;123–126. © 2000 Harcourt Publishers Ltd.THE SCIENTIFIC REVIEW OF ALTERNATIVE MEDICINE Vol. 5, No. 2 (Spring 2001)ORIGIN OF THE CLAIMSLAMENTS ABOUT THE STATE OF CONVENTIONAL MEDicineare nothing new. In 1861, Oliver WendellHolmes wrote: “I firmly believe that if the whole materiamedica as used now, could be sunk to the bottom of thesea, it would be all the better for mankind—and all theworse for the fishes.” 2 The original claim that “it hasbeen estimated that only 10 to 20% of all procedures currentlyused in medical practice have been shown to be efficaciousby controlled trial” first appeared in print in adocument published by the U.S. Congressional Office ofTechnology Assessment (OTA) in 1979 3 and was repeatedin 1983. 4 The claim stems from the comments ofOTA advisory panel member and noted epidemiologistKerr White. Dr. White based his informal “10 to 20%”estimate on a 1963 paper that reported on two surveys ofthe prescribing practices of 19 family doctors in anorthern British town for 2 weeks (one conducted inDecember 1960, and another in March 1961). 5 Interestingly,the paper was never intended to evaluate the scienceof medical practice; rather, its purpose was to looktoward controlling prescribing costs in terms of standard(i.e., “generic”) versus “proprietary” drugs. The “intent”of each prescription was analyzed according to how specificit was for the condition. Intent was “specific” for thecondition for which it was prescribed only about 10% ofthe time; “probable” in about 22%; “possible” in 26%;“hopeful” in 28%; “placebo” in 10%; and “not stated” in3.6%. From these data White estimated that “specificmeasures” accounted for 10 to 20% of the benefits of pa-104

Evidence-Based Medicine
Evidence-based medicine (EBM)
Evidence-based Medicine Workbook - Simorgh Research Repository
Adherence to Evidence Based Medicine & Guidelines
Evidence Based Medicine in the Age of the Internet
systematic reviews, meta-analysis & evidence based medicine
Evidence Based Medicine Matters - Sense about Science
The emerging evidence base for complementary medicines in ...
Essential Evidence-based Medicine, Second Edition (Essential ...
Evidence Based Interventional Pain Medicine according to Clinical ...
WHAT IS EVIDENCE BASED MEDICINE? - Rehabilitation Research ...
Evidence-based Medicine and the Changing Nature of Health Care ...
Herbal Medicines in Pregnancy and Lactation : An Evidence-based ...
Evidence-based Medicine and the Pelvic Girdle
EVIDENCE-BASED MEDICINE AND HYPERBARIC PRACTICE
Evidence Based Medicine in Neurosonology - Cochrane ...
WHAT IS EVIDENCE BASED MEDICINE? - Rehabilitation Research ...
WHAT IS EVIDENCE BASED MEDICINE? - Rehabilitation Research ...
Evidence based-approach in organizational and occupational ...
Evidence based medicine - challenges in cariology
Evidence-Based Medicine in Foot and Ankle Surgery
Evidence-Based
Evidence-based Medicine Guidelines to DES Use - summitMD.com
Evidence-Based Family Medicine - SQU Home
Evidence-Based-Psychological-Interventions
THE ART OF CHILDREN'S MEDICINE - Ann & Robert H. Lurie ...