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
>>>
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