January 24, 2014

Commentary: Medical “best practice” often no more than opinion

Is Evidence Based Medicine enough?
There is a lot of very good research guiding the practice of medicine – both conventional and naturopathic – and this research gives doctors a basis on which to recommend certain treatments for our patients.
But is medicine really as evidence based as we think it is?
An article published last week reveals that only about one in seven recommendations made by doctors are actually based on high quality evidence.
Additionally, more than half of recommendations rely solely on expert opinion or anecdotal evidence.
So it turns out that not all recommendations and treatments commonly used in medicine have been well studied – contrary to what most of us believe.
But this does not mean that six out of every seven recommendations are bad ones!

High Quality Evidence Is Nice, But Not Always Necessary
Do you need to see a double blinded, randomized controlled study to know if you should wear a parachute when skydiving? No. From observation, we know falling from high places will hurt us, so we wear parachutes.
Sometimes a study is not necessary to know what to do. Experience answers our questions. The same is true in medicine.
Although doctors often have plenty of evidence to guide them in their care of patients, at times they rely on clinical experience, the experience of experts, and even anecdotal evidence.
This is still good medicine! This is how medicine has always been practiced, across all disciplines.

Why is the evidence so often limited?
There is a limit to how many things can be fully and exhaustively researched. Priority has always gone to treatments that can be made profitable (in order to recover the money invested in the research).
The problem is that many good treatments are not all that profitable, and therefore are not studied.
Now, if we were to adhere to an evidence-based-medicine-only stance, doctors would find themselves in the uncomfortable position of withholding effective and safe treatments from their patients.
Fortunately most doctors recognize the importance of an open mind, because this is how we learn new things and advance medicine.

Link to original Reuters article: http://www.reuters.com/article/idUSTRE70A06J20110111

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