Dear All

Thanks for the interesting discussion.

We based the DPhil in EBHC on the presumption that EB practice is an
approach, not a science. The people on the programme so far are working on
clinical topic areas, but I think it would be fair to say that the clinical
topics are serving as a vehicle to explore issues arising from the
application of evidence in the real world. 

Janet Harris, MA, PhD
Academic Director, Health Sciences
Continuing Professional Development Centre
Department for Continuing Education
University of Oxford
Littlegate House, 16/17 St. Ebbes Street
Oxford  England
OX1 1PT
44 (0) 1865 286944

www.conted.ox.ac.uk/health

-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of brnbaum
Sent: 11 July 2006 16:48
To: [log in to unmask]
Subject: Re: more on Why is EBM important?- Real world- not Ivory Tower
opinion

Benjamin Djulbegovic posted:
> I am afraid he is right- EBM has been hijacked... 
> ...but if I ask you how will you differentiate the answer to the 
> question by the EBM "purists" vs. those who knowingly or unknowingly 
> distort evidence but using EBM language, what would be a difference in 
> technical, practical terms? Perhaps, follow-up question to this long
> comment is "   Is EBM a field of science or not?" (I noticed that Paul
> Glasziou announced in some of his earlier e-mail messages PhD program 
> at his center. This means that at least some people think that EBM is 
> science).

This sounds very familiar to the question of whether epidemiology is a
science (with the central hypothesis that disease is not distributed
randomly) or just a discipline. As an epidemiologist who teaches
evidence-based practice, I prefer to think that it is an approach, a
discipline, rather than a branch of science per se.

--
David Birnbaum, PhD, MPH
Visiting Associate Professor
School of Nursing
University of British Columbia
Principal, Applied Epidemiology
British Columbia, Canada


-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Ghosh, Amit K.
M.D.
Sent: 30 June 2006 14:57
To: [log in to unmask]
Subject: Re: Why is EBM Important?

I do agree with Bill on his excellent analysis. 
However I would like to add that till the Sackett and Guyatt's introduction
of the discipline of EBM I am not sure if we did look into studies as
critically as we do now.
Medical curriculum was deficient in this aspect and even now in many places
only catching up. 

The bigger question remains whether teaching the basics of EBM would be an
answer to all the problems when the physician has little control on anything
else. The over simplistic way to think is that critically reviewing an
article would provide the best evidence for the patient( we don't make that
promise any more). The issues surrounding successful implementation of  EBM
in medical schools  are far more complicated with mega secondary sources of
information like UpToDate and others coming to the physicians rescue more
frequently than the complicated juggernaut of negotiating the 4 S model (
systems, synthesis, secondary sources, studies). In all fairness despite it
great precision and depth, Cochrane reviews are hard to digest in the time
that any practitioner will ever have( average review is 50 pages ).
The final blame always falls in our inability to fulfill the promise that
many of us make that  teaching EBM will it solve most the problems.
In all its simplicity and complexity EBM has unraveled a whole set of issues
confronting medical education and medical practice and we thank the McMaster
Group for this step forward. How we finally use EBM in an uniform fashion,
all around the globe remains the experiment for the near  future.


Amit K. Ghosh, MD, FACP
Associate Professor of Medicine
Associate Program Director,
General Internal Medicine Research Fellowship Mayo Clinic College of
Medicine 200 First Street SW Rochester, MN, USA 55905 Phone : 507-538-1128
(Clinical)
            507-284-4967 (Administrative)
Fax:      507-284-4959
Email: [log in to unmask]


-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Bill Cayley, Jr
Sent: Friday, June 30, 2006 8:26 AM
To: [log in to unmask]
Subject: Why is EBM Important?

Here's my answer - along the lines of the introduction I give our medical
students:

In medicine, we are continually making decisions, and if medicine is to be a
science or a "learned"
profession, we need to think critically about HOW and WHY we make those
decisions. There are a number of potential approaches to making decisions:
1) Tradition ("we've always done it this way", "my teachers did it this
way"); 2) Convention ("everyone else always does it this way" - ie, going
with the crowd), 3) Belief or Dogma ("I believe the natural way is best"),
4) "Evidence-based" - that is based on some sort of systematic assessment of
evidence.

Further, I discuss with my students the fact that you can look at evidence
as simply ANY observation about the nature of the world. In the medical
literature, we call a single, isolated instance of something an "anecdote"
(or, if published, a "case report").  If you take a bunch of observations
and group them together, we have a "case series".  You can go on up from
there in terms of the rigor, systematization, and thoroughness of evidence
evaluation up to the double-blinded randomized trial or the meta-analysis. 
ALL observations can be considered "evidence" - it's just a matter of asking
what the QUALITY of your evidence is.

So, I see evidence-based medicine as the effort to critically examine the
reasons we do what we do, and the information or evidence that supports it.
In one sense, ALL medicine is "Evidence-Based Medicine" - it's just that if
you practice medicine without thinking critically about what you do and
without looking for high-quality evidence (or at least the highest quality
available) then you are practice medicine based on very LOW-quality
evidence.


Bill C