The discussion is indeed interesting, but
simple dichotomy “EBM efficient” “EBM non-efficient”
does not apply and is not quite testable. Some religious people don’t
need any proof of God, and I feel great about it. The compelling evidence that
EBM is working is in the nature of EBM the methods of getting proof. Frequentist
and Bayesian reasoning clash here, but the result is not a complete
annihilation as some may insist, but the birth of a mechanism on how to transit
from population research to individual patient level.
The fundamental book of M.Hunink and P.Glasziou
Decision Analysis in health and Medicine: Integration Evidence and Values
is indeed a classic text and the compelling answer.
Sure it is all about how to benefit the
community with the most efficient medical interventions using the resources
they have.
Nik
From: Evidence based
health (EBH) [mailto:[log in to unmask]] On Behalf Of Hilda Bastian
Sent: Friday, May 10, 2013 5:41 AM
To:
[log in to unmask]
Subject: Re: EBM and
Person-centred care - can you have one without the other?
Hi there! Yes, I see what you mean. For me, the problem is partly that
I think in this instance - EBM - "EBM" isn't a thing at all:
it's more like a statement "music is a good thing and it should be one of
the things that people consider when they want to be entertained, distracted or
affected" and the adherents of that philosophy.
If you try to separate "it" from the
practices/actions/priorities it is encouraging, then I don't think there is any
"thing" left. It becomes only a vague statement of belief - something
like "the best evidence should be considered along with other things"
where the meaning of the component words/phrases is interpreted
differently/contested anyway. Embedded in the notion are things like "there
should be more rationality and probabilistic thinking rather than going with
the gut/(manipulated) flow in medicine". And "effects matter and
things should be rigorously evaluated and those evaluations should influence
what happens next." And of course, even without the articulation of
something called EBM, those things existed. EBM then is characterized by its
particular "things" - in particular, the systematic review, the
trial, probabilistic statistics.
What there is, is a lobby/community for particular types of changes to
health research, health information, healthcare practice, health
regulation/payment, health professional education etc, and the interventions
being promoted that would make these things different to the way they would
have been without a lobby for those changes. And if that lobby rallying around
those changes that people want to see (very loosely categorized as
"believing in EBM") hadn't existed, we would be better or worse off
or no different, in different ways.
Tried not to use the word paradigm, but really, isn't that what's left
about what "EBM" is, if it's not its interventions and its
lobby/community? This thing formed, but other things would have emerged if this
hadn't existed. Maybe it's neither music nor performance: it's a kind of
"rules" for musicians and audience, and its school of adherents,
perhaps.
Hilda
On Fri, May 10, 2013 at 4:54 AM, Michael Power <[log in to unmask]>
wrote:
Thanks Amy and Hilda
I was trying to clarify the difference between evidence on "the effects of
EBM systems" and evidence on "EBM".
To use a musical analogy, this is the difference between evaluating a
performance and evaluating the music - hitting headlines this morning is the
cancellation of a new production of Richard Wagner's Tannhauser. The problem
was not with the music, but with the Nazi overtones in the production.
Critics of EBM point out problems with the performance and make it seem that
there are problems with the music - examples available on request.
There is a similar problem with defining and explaining EBM. If you define or
evaluate EBM by outcomes or applications, you are assuming that the performance
IS the music. How will you improve your performance or develop a totally new
production for your show?
Changing the metaphor, I prefer to think of EBM more as a journey guided by the
aspiration to make optimal decisions (our fixed star) than an itinerary with
route and destinations that must continually evolve even if they were initially
predefined.
Michael