Hi Amy: At the risk of raising the ire of people I would suggest one does not need to have evidence that EBM changes healthcare - either positively or negatively.
In my mind, the concept of EBM or evidence-based healthcare (EBHC) is a philosophy - it is an approach as to how we should practice heath care.
Personally, I believe one should for all health care decisions:
1) use the best available evidence
2) use one’s clinical expertise/experience, and
3) integrate patients' values and preferences into the decision making process
Are there people who disagree with these three recommendations?
The reason I say it is a philosophy and not something that needs to show it improves outcomes is because using EBM could in theory “worsen” health outcomes.
As an example, lets assume we did an RCT of statin use in primary prevention and randomized people to either taking a statin or EBHC (making the choice for themselves)
For the sake of the argument let’s assume that
1) statins definitely reduce the risk of cardiovascular disease by 25% or roughly 1-2% over 5 years in primary prevention
2) statins do NOT cause any side effects (I know this is not true)
3) let’s assume that most people when give the absolute benefit numbers would decide not to take a pill every day for five years
With these assumptions, the people that got randomized to choosing for themselves would have more CVD than the group that was “forced” to take a statin.
I would suggest that the outcome doesn’t matter - regardless of the outcome, practicing EBHC is simply the right thing to do.
Thoughts from our illustrious list-serve?
James
> On May 20, 2016, at 7:42 PM, Amy Price <[log in to unmask]> wrote:
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> Dear all.
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> I am looking for concrete examples of EBM changing healthcare practice. I see arguments and methods but lack examples other than personal or with those I have worked with to say the practice of EBM changed healthcare specifically. E.G. reduced harm be forcing the recall of a harmful drug, the discovery of a better way to treat a specific disease etc. Please help I think we need to build a history for the world outside EBM.
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> Best
> Amy
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