Is evidence-based medicine broken? – Hormone Choice Singapore

This article by Trish Greenhalgh, Professor of Primary Health Care and Dean for Research Impact at Barts and the London School of Medicine and Dentistry, looks at the controversy surrounding evidence based medicine.

She finds that (bolding by HCS)

. . . the attempted solution – hard-wiring the guidelines into computerized “decision support tools” – has been largely a flop, given computer models’ inability to accommodate messy, real-world clinical practice. For example, generations of medical students have memorized the textbook features of celiac disease for their examinations. But your Aunt Nora’s celiac disease has not read the textbook.

Indeed, only Aunt Nora can tell you how her celiac disease behaves. She also happens to be opposed to taking blue-colored pills. And she insists that, years ago, when she took drug x, it made her feel like a new woman – despite the fact that, in 1,000 patients, drug x has demonstrated, on average, no effect. The computer model’s treatment recommendations would probably not work for Aunt Nora.

But this does not mean that evidence-based medicine is broken; it simply lacks the needed maturity. High-quality randomized trials are as important now as they were at the time of the evidence-based movement’s founding. But the system must be shaped by the doctor’s judgment and the patient’s individual experience.

She later states:

. . . research-derived facts about the average patient must not outweigh individual patients’ observations of their own bodies and illnesses. New processes for capturing and accommodating patients’ personal experiences – which are typically idiosyncratic, subjective, and impossible to standardize – would go a long way toward ensuring that each patient receives the right treatment.

Read the whole article at:

http://www.project-syndicate.org/commentary/is-evidence-based-medicine-broken-by-trish-greenhalgh-2014-10

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