These suggestions are good and relevant, but they are value judgments!
Donald E. Stanley FCAP
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Nobleboro, ME
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From: Evidence based health (EBH) <[log in to unmask]> on behalf of Michael Power <[log in to unmask]>
Sent: Thursday, October 7, 2021 7:25:17 AM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: What does EBP look like?
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Thanks David for raising this issue
I think that there is a fundamental mistake in the way that EBM is discussed as if it is a well-defined process/set of practices. In fact there are many different practices or versions of EBM. The diversity reflects differences in contexts and differences in values.
If there is to be an EBM 2.0, I would suggest that it be based on explicit statements about its underlying values. This would prevent strawman arguments about the deficiencies of their perception of EBM -- those with long memories may remember who I am thinking of.
A list to start the debate might include:
* Evidence should be as truthful as possible
* scientific data is only "true for now"
* uncertainties need to be confronted
* statistical variation needs to be measured
* risks of bias and error need to be estimated
* Evidence should be as relevant as possible to the inference being drawn on a clinical decision
* proxy vs actual clinical outcomes
* selected outcomes vs all outcomes
* Inferences should be as relevant as possible to the intended people
* the individual patient
* group of patients
* community
* society
* Fairness and efficiency requires taking into account inter alia
* opportunity costs
* cost-effectiveness and willingness to pay
* Personal autonomy
* Benevolence and non-maleficence
* Democratic approach when values conflict
* ...
The application of the FDA's Accelerated Approval Pathway to aducanumab has provoked a fair amount of discussion in the general medical journals recently. It might be interesting to apply the above checklist to articles criticising the FDA and to the FDA's explanation of their decision. The question that this immediately raises in my mind is when is it not OK to outsource clinical and funding decision-making to a body of experts such as a regulator or guideline producer?
Michael
On Fri, Oct 1, 2021 at 9:44 AM David Nunan <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Colleagues,
This recent article (entitled “Thirty years of teaching evidence-based medicine: have we been getting it all wrong?”), whilst re-visiting some well-trodden ground without adding much, poses some interesting points/questions I too have grappled with: https://link.springer.com/article/10.1007/s10459-021-10077-4#article-info<https://urldefense.com/v3/__https://link.springer.com/article/10.1007/s10459-021-10077-4*article-info__;Iw!!Npd4GBrkbw!nVvwjFKeuFcppOP3vNrzBXrIBOUkoul0JLH-TyiMETEGzMlqsZcR3E2pTC8$>
Most important to me are:
1. What does “doing” evidence-based medicine/health care look like in practice (especially now in 2021)?
2. Who are the role models doing 1.?
3. Do we need an EBM 2.0? (I think we do)
I’m preparing a blog on these points. I would welcome discussion and any help with answers to these questions.
Best,
David
David Nunan PhD
Director, PG Certificate in Teaching Evidence-Based Health Care<https://urldefense.com/v3/__https://www.conted.ox.ac.uk/about/postgraduate-certificate-in-teaching-evidence-based-health-care__;!!Npd4GBrkbw!nVvwjFKeuFcppOP3vNrzBXrIBOUkoul0JLH-TyiMETEGzMlqsZcRaNCbvTk$>
Senior Research Fellow and Departmental Lecturer
Lead tutor, Practice of Evidence-Based Health Care<https://urldefense.com/v3/__https://www.conted.ox.ac.uk/courses/practice-of-evidence-based-health-care__;!!Npd4GBrkbw!nVvwjFKeuFcppOP3vNrzBXrIBOUkoul0JLH-TyiMETEGzMlqsZcRlYAnKrA$>
Visiting Professor in EBM, Petrópolis Medical School, Brazil
Fellow of Kellogg College
Associate Editor, BMJ Evidence-Based Medicine
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