In my view Evidence Based
Practice (EBP) takes into account both the available empirical evidence and also the contextual evidence relating to the particular case (that person at that point in time) including patient characteristics, comorbidities, patient & practitioner values,
ethical, legal, policy, resource constraints, relative risks given to various benefits and harms of intervening or not intervening. In combination this leads to (hopefully shared) clinical decision-making. We need to consider both types of evidence – it is
not either/or. See http://fampra.oxfordjournals.org/content/28/2/123.full.pdf+html
My conflict of interest declared: I am Editor of the Journal of Primary Health Care in which Greenhalgh’s editorial is published.
Felicity Goodyear-Smith
Felicity Goodyear-Smith MB ChB MD FRNZCGP
Professor & Goodfellow Postgraduate Chair
Editor-in-Chief,
Journal of Primary Health Care
Department of General Practice & Primary Health Care
University of Auckland
PB 92 019 Auckland 1142
New Zealand
Tel DD +64 (0) 9 923 2357
Mob +64 (0) 21 897 244
Fax: +64 (0) 373 7624
From: Evidence based health (EBH) [mailto:[log in to unmask]]
On Behalf Of Poses, Roy
Sent: Friday, 6 July 2012 8:01 a.m.
To: [log in to unmask]
Subject: Re: Editorial by Greenhalgh
Greenhalgh seems confused, perhaps deliberately, between true EBM, and people who call what they are doing "evidence-based" as a marketing or public relations ploy.
On Tue, Jul 3, 2012 at 12:54 PM, Amy Price <[log in to unmask]> wrote:
I find this quote particularly onerous "On the other hand, I think something sinister is happening, mainly because
of the striking circumstantial resonance between the reductionism of EBM and the reductionism of contemporary policymaking".
How is this not a slap in the face? I as a newly minted EBHC student have already been forced to justify by several as if this was a done deal and we are no better than Pharma and their 3b
fiasco. People understand this to mean that we are using EBM to rob people of their healthcare rights. Junk science medics are saying see we are free, people that practice EBM are bought and paid for bean counters. If they challenge me, who has not challenged
back, has little public exposure and is not making any income on this how do you think this wave is going to roll for those who have invested their research in this practice….
Everything that can be will be used to control behavior and it is good to be aware but more importantly what constructive plans are in place to neutralize this in tangible ways? Fanaticism
is rampant in all disciplines and is a reflection of lack of understanding and personality involved. EBHC is not a religion it is a dynamic clinical tool to promote understanding/discerning of quality research and clinical care
Amy
--
Roy M. Poses MD FACP
President
Foundation for Integrity and Responsibility in Medicine (FIRM)
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Clinical Associate Professor of Medicine
Alpert Medical School, Brown University
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