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All excellent questions and any response to them is better patient care than anecdotal, financial or peer formulated. A small step forward but it is a step. -- Preston H. Long > From: "Djulbegovic, Benjamin" <[log in to unmask]> > Reply-To: "Djulbegovic, Benjamin" <[log in to unmask]> > Date: Tue, 5 Jun 2001 11:36:18 -0400 > To: [log in to unmask] > Subject: Re: Is EBM Effective? > > Your response indicates how difficult is to define a practice of EBM. What > about systematic reviews/meta-analysis? Would you prefer them over RCTs? How > do you take into account the quality of RCTs vs SR/MA? What if there are two > or more trials, with conflicting results (as it is often the case) etc. What > if RCTs or SRs are simply not available? Are we then non-EBM physicians? > etc, etc... > ben > > > > -----Original Message----- > From: preston [mailto:[log in to unmask]] > Sent: Tuesday, June 05, 2001 10:59 AM > To: Djulbegovic, Benjamin; [log in to unmask] > Subject: Re: Is EBM Effective? > > > RCT less than 24 months old. > -- > Preston H. Long > >> From: "Djulbegovic, Benjamin" <[log in to unmask]> >> Reply-To: "Djulbegovic, Benjamin" <[log in to unmask]> >> Date: Tue, 5 Jun 2001 08:41:27 -0400 >> To: [log in to unmask] >> Subject: Re: Is EBM Effective? >> >> But, how do you define "the most current and up to date info"? >> ben >> >> >> -----Original Message----- >> From: preston [mailto:[log in to unmask]] >> Sent: Tuesday, June 05, 2001 8:32 AM >> To: Djulbegovic, Benjamin; [log in to unmask] >> Subject: Re: Is EBM Effective? >> >> >> To me an EBM provider uses the most current and up to date info in his >> practice. I find reasons why providers don't use EBM far more interesting. >> Some reasons offered have been ignorance, peer pressure, financial > incentive >> and reward. William J. Mayo said,"The best interest of the patient is the >> only interest to be considered." I am currently involved in a study >> comparing EBM to placebo and conventional treatments of a condition. >> -- >> Preston H. Long >> >>> From: "Djulbegovic, Benjamin" <[log in to unmask]> >>> Reply-To: "Djulbegovic, Benjamin" <[log in to unmask]> >>> Date: Tue, 5 Jun 2001 08:22:13 -0400 >>> To: [log in to unmask] >>> Subject: Re: Is EBM Effective? >>> >>> Since there has been some lamenting recently about the lack of activity > on >>> this group, to add some "fuel" (pointing to the difficulties if not >>> impossibility of conducting a study proposed below), I would just like to >>> ask: >>> "how would one define an "EBM doctor"? Let's say someone would like to >> fund >>> such a study: What definitions of EBM vs. non-EBM doctors would you use? >>> (Actually, I am not trying to be a provocative here. It is just after > many >>> years of teaching and hopefully practicing EBM, I came to conclusion that >>> the value of EBM should not be evaluated against non-EBM, but should be >>> sought in the understanding of the quality of our knowledge, as I >> described >>> in my message from yesterday). >>> >>> hope we can get some stimulating discussion going... >>> >>> ben >>> >>> -----Original Message----- >>> From: jordanra [mailto:[log in to unmask]] >>> Sent: Tuesday, June 05, 2001 7:01 AM >>> To: [log in to unmask] >>> Subject: Re: Is EBM Effective? >>> >>> >>> Agree with what has been said, but would add, that EBM might also assist >> in >>> building more realistic expectations into the physician/patient >> relationship >>> and medical science. A major challange however, is for physicians to >>> develop the necessary communication skills. (And to some degree, for the >>> average patient to develop some educated listening skills). >>> >>> R. Jordan >>> LTC, MC >>> Commander >>> U. S. Army Medical Activity, Japan >>> >>> ----- Original Message ----- >>> From: "Marjan Kljakovic" <[log in to unmask]> >>> To: <[log in to unmask]> >>> Sent: Tuesday, June 05, 2001 7:01 AM >>> Subject: Re: Is EBM Effective? >>> >>> >>>> I read with interest the angst around trying to see whether teaching >>>> EBM is effective on patient outcomes. I think Toby Lipman hit the nail >>>> on the head when he wrote >>>> "Surely using patient outcomes is a far too complex end-point for a >>>> study of the effectiveness of EBM?" >>>> >>>> The issue of compexity is pivotal in understanding why the >>>> effectiveness of EBM teaching will be ellusive. >>>> >>>> The core of activity in general practice (for doctors) is the doctor / >>>> patient / illness relationship. EBM is a technique used by the doctor > to >>>> try and influence that relationship so that a desired outcome might be >>>> achieved with respect to an illness. >>>> >>>> As a teacher of EBM with undergraduate and post graduate medical >>>> students, I live in the hope that I have an effect on patient outcomes >>>> which those students will create with their future patients. I use the >>>> word "hope" because I am sure that what I teach is at least two steps >>>> back from any patient outcome: >>>> >>>> I would encourage research into the various relationships that are >>>> inherent in the steps between the teacher of EBM and the desired >>>> outcomes. We need more qualitative research to answer questions >>>> on relationship issues such as >>>> "How can teachers influence students to take EBM seriously?" >>>> "How do student carry EBM teaching into clinical practice?" >>>> "How do patients perceive the "EBM" doctor" compared to the >>>> "non-EBM doctor?" >>>> Cheers >>>> Marjan >>>> >>>> >>>> The whole matter is complex because we need to understand that >>>> there is >>>>