Peter as I have come to learn in evidence-based medicine, is correct in that a main aspect of evidence-based medicine is the inclusion of the patient in the decision making, taking their preferences and needs and the like and input into account...explaining them the options...I guess akin to the example of trying to get the patient's consent and understanding of your treatment by explaining to someone that a condition with a 10% risk of occurring will have a treatment benefit of 1% with a particular therapeutic intervention, versus a condition that carries a 100% risk of occurring and have a 1% decline following intervention...it will be very important and feasable to the patient facing a near certainty of a poor outcome...and in this manner...to me as I wrestle with the evidence-based approch to science, public health etc., is the issue of clinical significance versus statistical significance and causes me now as I read research to ask..."so what?" "what is the value of this to the patient, the public"?

Dan - you missed one thing - when applying the evidence in individual cases, the clinician must also take into account the preferences of the patient. It is not just applying what is reasonable and necessary based on evidence (or of mindlessly following guidelines), but also what is suitable to the individual patient. You should use the evidence to advise the patient of likely outcomes of specific interventions (including always the outcomes of using no intervention at all) This is the factor always disregarded by critics of evidence-based practice. Peter Renshaw Australia On 27/12/2008, at 8:22 AM, Dan Abshear wrote: > According to others, evidence-based medicine is where the health care > provider applies statistically significant and relevant evidence acquired through > quality and valid clinical trials utilizing the scientific method. The health care > providers assess the risks and benefits of how they choose to treat or not to > treat their patients. This paradigm of a practicing health care provider is to > better predict the outcomes of their treatment of their patients. Such > providers recognize the need for quality in medicine and place tremendous > value on their patients' lives. This paradigm of restoring the health of others > protects public health. > There are three areas of evidence-based medicine: > 1. Treat patients according to what is reasonable and necessary based on > the evidence that exists regarding the treatment options health care providers > select. > 2. Health care providers review this evidence in order to judge and assess the > best treatment for their patients. > 3. Recognize that evidence-based medicine is in fact a movement that > emphasizes the usefulness of this method to practice medicine. > > Two types of evidence-based medicine: > 1. Evidence-based guidelines- Policies and regulations are produced to ensure > optimal health care. > 2. Evidence-based individual decision making- This is how restoring the health > of others is practiced by the health care provider. > This is the preferred way to practice medicine instead of medical guidelines, > which are created from a combination of clinical studies in which conclusions > are drawn to reflect national standards of care for a particular disease state. > Guidelines were implemented during the 1980s. At times, these guidelines are > privately sponsored, which makes them unreliable due to bias and without > independent systematic review or quality considerations by others. Unlike > evidence-based medicine, guidelines can have major flaws and inaccuracies > due to toxic factors used to create such guidelines. In fact, most doctors do > not follow medical guidelines, yet are rewarded by programs such as Medicare > if they do follow medical guidelines that are established. > > Dan Abshear