Toby
You raise an interesting question about the potential consequences of EBM
and I would like to respond from a consumer perspective. Most consumers
actually assume that health care practices and treatments are based on
evidence - so it comes as quite a shock when they discover this is often not
the case. So I do feel practitioners have a responsibility to ensure there
is evidence to support their practice as well as any recommendations they
make to patients in relation to treatment/therapy options. I support the
Cochrane approach that if there is insufficient evidence to use or not to
use then the treatment/therapy should be used within a research setting so
the necessary evidence can be obtained and the safeguards associated with
studies (including consent processes) put in place.
Whilst I am enthusiastic about the potential benefits for consumers of
evidence based practice (not just medicine) I am also aware of some
potential pitfalls. For instance, people can look at the same evidence and
perceive it in different ways. The way evidence is expressed and presented
to people can also be misused to unduly influence decision-making. An equal
weighting is generally not given to evidence - so some evidence will be
enthusiastically promoted to consumers/patients whereas other less popular
evidence is not made available.
The same evidence may also be encouraging for some but offputting for
others. The systematic review on cord care (use of a preparation applied to
the cord stump of a newborn baby compared with no preparation to reduce
infection) is a really good example of how the same evidence can be
perceived in different ways. Briefly, the review concludes that where a
preparation is not used on the cord the amount of colonisation of bacteria
increases but the level of infection does not. In one service I am aware of,
practitioners and women have found this to be reassuring evidence that the
cord can just be left without any routine intervention being needed and see
the increased level of colonisation to be evidence of the normal rotting
process of the cord. Infection control people on the other hand consider the
evidence of increased colonisation to be justification for cord preparations
to be applied as they argue that where there is increased colonisation of
bacteria there is increased risk of infection!
The main value for consumers is that there be access to good quality
evidence to assist with decision making. However, the evidence does need to
be available in a user friendly form that is meaningful to consumers. The
Cochrane Collaboration performs an excellent role in this respect as do
those who have developed evidence-based guidelines with consumer-friendly
versions. Practitioners also need to stop acting as information gate-keepers
so consumers can have equitable access to the information needed.
Judi Strid
Women's Health Action
(consumer advocacy group based in Auckland, New Zealand)
> -----Original Message-----
> From: Toby Lipman [SMTP:[log in to unmask]]
> Sent: Monday, January 15, 2001 3:41 AM
> To: [log in to unmask]
> Subject: Re: Consequences to practitioners of ebm
>
> In message <001e01c07e34$b3b72fa0$3d2968d5@default>, thethoughtfactory
> <[log in to unmask]> writes
> > I see EBP/EBM as an innovation and
> >my question to everyone is :
> >What are the consequences to you of practicing EBM/EBP?
> >Is there any literature other than the pro-EBM lobby output? Does anyone
> think
> >that EBM could be detirmental? If so why?
> >
> You could start with "Evidence-Based Practice: a critial appraisal" eds
> Trinder and Reynolds. Oxford, Blackwell Science 2000 ISBN 0-632-05058-6
>
> This has both pro and anti-EBM chapters and also looks at its
> consequences for other fields than medicine, such as education, social
> work and human resource management
>
> Toby
>
> --
> Toby Lipman
> General practitioner, Newcastle upon Tyne
> Northern and Yorkshire research training fellow
>
> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>
> Northern and Yorkshire Evidence-Based Practice Workshops
>
> http://www.eb-practice.fsnet.co.uk/
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