I do agree with Bill on his excellent analysis.
However I would like to add that till the Sackett and Guyatt's introduction of the discipline of EBM I am not sure if we did look into studies as critically as we do now.
Medical curriculum was deficient in this aspect and even now in many places only catching up.
The bigger question remains whether teaching the basics of EBM would be an answer to all the problems when the physician has little control on anything else. The over simplistic way to think is that critically reviewing an article would provide the best evidence for the patient( we don't make that promise any more). The issues surrounding successful implementation of EBM in medical schools are far more complicated with mega secondary sources of information like UpToDate and others coming to the physicians rescue more frequently than the complicated juggernaut of negotiating the 4 S model ( systems, synthesis, secondary sources, studies). In all fairness despite it great precision and depth, Cochrane reviews are hard to digest in the time that any practitioner will ever have( average review is 50 pages ).
The final blame always falls in our inability to fulfill the promise that many of us make that teaching EBM will it solve most the problems.
In all its simplicity and complexity EBM has unraveled a whole set of issues confronting medical education and medical practice and we thank the McMaster Group for this step forward. How we finally use EBM in an uniform fashion, all around the globe remains the experiment for the near future.
Amit K. Ghosh, MD, FACP
Associate Professor of Medicine
Associate Program Director,
General Internal Medicine Research Fellowship
Mayo Clinic College of Medicine
200 First Street SW
Phone : 507-538-1128 (Clinical)
Email: [log in to unmask]
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Bill Cayley, Jr
Sent: Friday, June 30, 2006 8:26 AM
To: [log in to unmask]
Subject: Why is EBM Important?
Here's my answer - along the lines of the introduction
I give our medical students:
In medicine, we are continually making decisions, and
if medicine is to be a science or a "learned"
profession, we need to think critically about HOW and
WHY we make those decisions. There are a number of
potential approaches to making decisions: 1) Tradition
("we've always done it this way", "my teachers did it
this way"); 2) Convention ("everyone else always does
it this way" - ie, going with the crowd), 3) Belief or
Dogma ("I believe the natural way is best"), 4)
"Evidence-based" - that is based on some sort of
systematic assessment of evidence.
Further, I discuss with my students the fact that you
can look at evidence as simply ANY observation about
the nature of the world. In the medical literature, we
call a single, isolated instance of something an
"anecdote" (or, if published, a "case report"). If
you take a bunch of observations and group them
together, we have a "case series". You can go on up
from there in terms of the rigor, systematization, and
thoroughness of evidence evaluation up to the
double-blinded randomized trial or the meta-analysis.
ALL observations can be considered "evidence" - it's
just a matter of asking what the QUALITY of your
So, I see evidence-based medicine as the effort to
critically examine the reasons we do what we do, and
the information or evidence that supports it. In one
sense, ALL medicine is "Evidence-Based Medicine" -
it's just that if you practice medicine without
thinking critically about what you do and without
looking for high-quality evidence (or at least the
highest quality available) then you are practice
medicine based on very LOW-quality evidence.
--- Olive Goddard <[log in to unmask]>
> Dear Colleagues,
> Here's a question some of you might like to respond
> All good wishes,
> >>> "Gang Jiang" <[log in to unmask]>
> 29/06/2006 16:16 >>>
> Dear Sir/Madam:
> I am very interested in evidence based medicine.
> Could you please tell
> me why EBM is important? Can a physician practise
> medicine without
> knowing EBM?
> Thank you,
> Gang Jiang
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Bill Cayley, Jr, MD MDiv [log in to unmask]
Augusta Family Medicine Home Address
207 W Lincoln 3433 McIvor St
Augusta, WI 54722 Eau Claire, WI 54701
Work: 715-286-2270 Home: 715-830-0932
Page: 715-838-7940 Cell: 715-828-4636