Evidence-Based Medicine

What is evidence-based medicine?

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Evidence-based medicine (EBM) is as its name suggests - the application of medicine and healthcare based on the best available current evidence.

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Evidence-based medicine is specifically medicine that will adapt alongside new data and scientific discoveries. When clinical practice follows evidence-based medicine, it provides the best and most up-to-date care for patients. Thus, EBM is a fundamental cornerstone in the fast-paced world of healthcare.

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The journey of evidence-based medicine

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You may or may not be surprised to learn that medical treatments have not always followed evidence and indeed, this continues to be the case in many scenarios.

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From days of old, doctors have relied on their experience when treating patients and from days of even older, doctors have relied on hunches, medical traditions and even superstition. These approaches had their good and bad sides, but it could be inconsistent, based on guesswork and more often than not, fraught with subjectivity.

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As medicine and our understanding of health grew, the need for a more structured and evidence-driven approach became clear with evidence-based medicine beginning to take shape in the early 1990s. Instead of relying on tradition, feelings and conventional wisdom, doctors started using the best, most up-to-date scientific evidence to make decisions.

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Dr. David Sackett, a pioneer and arguably one of the 'fathers' of modern evidence-based medicine described it as:

"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

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Since then, evidence-based medicine has vastly transformed the landscape of healthcare with a huge paradigm shift in what is accepted medical practice over time, particularly over the last century.

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The time before evidence-based medicine

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Just imagine a couple of scenarios if time-honoured traditions did not evolve with scientific advances in medicine:

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Bloodletting

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Bloodletting has a history spanning over 3,000 years and was popular throughout Europe in the Middle Ages and was for a long time accepted medical practice. Illness was thought related to bad 'humours' in the body, and bloodletting was one way of purging 'disease' from the body. You would be rightly concerned if you attended the doctors today with a skin rash and the solution was to drain some of your blood.

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We now know that in fact for the vast majority of people, blood loss results in illness. We know this because modern medicine has developed the ability to measure and quantify objective blood markers through laboratory testing in order to determine illness.

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Mental illness and Superstition

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In historical contexts, mental health was often intertwined with superstition, leading to the belief that mental illnesses were manifestations of supernatural forces. In many societies, individuals exhibiting unusual or erratic behaviour were perceived as being possessed by evil spirits or demons that required some sort of 'cleansing'. The prevailing lack of scientific understanding and medical knowledge contributed to the reliance on mystical explanations and therefore exorcism was considered a legitimate treatment for mental disorders at one point.

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It wasn't until the development of modern psychiatry and the understanding of psychological disorders being multi-factorial in origin and rooted in biology, neurochemistry and socio-environmental factors that such superstitious beliefs began to give way to evidence-based medical approaches in the treatment of mental health issues. This was also a key proponent in the gradual destigmatisation of societal attitudes towards mental health.

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Challenges

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One of the big challenges in the field of evidence-based medicine is the overwhelming amount of medical information available in a rapidly evolving landscape. Doctors need to sift through all of it to find the best evidence, reach consensus, continually refine guidelines and then translate this into clinical practice, all within the confines of finite resources. Best practice may not always be followed and overcoming these challenges will require ongoing training and support for healthcare providers.

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On top of that in today's world, there are genuine concerns surrounding the growing amount of quackery and misleading medical information out there. The widespread use of online platforms has made it easier for unverified and pseudo-scientific health advice to circulate, putting individuals at risk of falling victim to inaccurate or downright fraudulent practices. People may be bamboozled into promises of quick fixes or treatments that aren't proven to work, potentially suffering financial loss but moreover delaying proper treatment and putting their well-being at risk.

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The future of evidence-based medicine

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The future of evidence-based medicine holds exciting prospects as the convergence of technology (such as AI, genomics) and diverse data sets (for example electronic health records, wearable device information) fosters a more personalised and dynamic approach to healthcare.

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Collaborative efforts between clinicians, researchers, and technology experts are likely to accelerate the translation of research findings into more patient-centred healthcare, ultimately improving patient outcomes and driving the evolution of evidence-based medicine into a more dynamic and adaptive framework.

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Overall, think of evidence-based medicine as being your healthcare GPS. It makes sure doctors have a roadmap to follow, based on the best information out there. It keeps you safe, helps you get the most from your healthcare, and pushes medicine forward. As we keep embracing the power of EBM through global information exchange, healthcare will keep getting better to ensure that everyone receives optimal care.

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Why is evidence-based medicine important?

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If you haven't already, take a read about evidence-based medicine in Part 1. In short, evidence-based medicine (EBM) is crucial for several reasons:

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Less guesswork, more certainty

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Evidence does not lie. It does not hold on to tradition or bias and it is not afraid to be wrong. If evidence emerges to the contrary of established medical thinking, this then becomes the new thinking. Antiquated, ineffective practices are thrown out with the adoption of safer, more effective practice. Evidence-based medicine is like a set of rules that everyone follows so there is standardisation and means you're more likely to get the same high-quality care no matter where you go.

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Better outcomes, ethical care

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Working on the principles of evidence-based medicine ensures that doctors make decisions based on the most recent and reliable scientific information. This way, you're less likely to get treatments that don't work or, even worse, harm you, upholding the ethical principles of medicine. Evidence-based medicine is about keeping patients safe and making sure the best care possible is offered which is of paramount importance.

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Pushing medical advancement

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The practice of evidence-based medicine serves as a catalyst for medical advancement. By promoting rigorous research and sound scientific practices, it fosters the continuous exploration of novel and innovative approaches to healthcare which contributes to enhanced patient care and better medical outcomes.

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Better resource allocation

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Healthcare resources like money and time are limited and so evidence-based medicine plays a crucial role in guiding the judicious allocation of these resources by focusing on treatments and practices that have been proven to work and are cost-effective.

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In essence, EBM is a powerful tool that elevates healthcare to a higher standard of evidence-driven decision-making, prioritizing patient well-being, ethical care, medical advancement, and efficient resource utilization.

How has evidence-based medicine influenced modern day healthcare?

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In part 3, we look at how evidence-based medicine has evolved over time and below are just some of the examples of how previously established medical practices have changed due to new evidence.

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If you haven't already, take a read of part 1 and part 2.

Treating blood pressure

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• Old practice: Doctors used to think that high blood pressure was a 'normal' part of getting old and that the benefits of treating this was unclear in the very elderly.
• New practice: Studies (such as the SHEP/HYVET and later SPRINT/SPRINT-Senior trials) have led to a re-evaluation of blood pressure targets and has demonstrated good evidence to support treating high blood pressure in the elderly also.

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Use of Aspirin as a preventative medicine

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• Old practice: Aspirin was commonly recommended to the general population to take in order to prevent a serious cardiovascular event e.g. a heart attack.
• New practice: New evidence suggests that the benefits of aspirin in preventing first-time heart attacks and strokes should be carefully weighed against the risk of bleeding. Guidelines now recommend a more individualised approach.

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Use of Diclofenac as a painkiller

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• Old practice: Diclofenac, a common pain reliever and anti-inflammatory drug, was often prescribed for various types of pain and inflammation, such as arthritis or injuries.
• New practice: Relatively recent evidence has shown that long-term use of diclofenac, especially in high doses, can be associated with an increased risk of heart problems. Doctors are now more cautious about prescribing it for extended periods, particularly for individuals with cardiovascular risk factors.

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Dietary recommendations for cholesterol

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• Old practice: There was an emphasis on restricting dietary cholesterol intake to lower blood cholesterol levels.
• New practice: Current evidence suggests that dietary cholesterol intake for most people has less impact on blood cholesterol levels than previously thought. Guidelines have shifted focus to our overall dietary patterns, emphasising the importance rather of reducing saturated and trans-fats in our diets.

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Prostate-Specific Antigen (PSA) testing

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• Old practice: Men often had routine PSA tests (blood testing) to check for prostate cancer.
• New practice: Due to concerns about over-diagnosis and unnecessary over-treatment, guidelines now recommend shared decision-making between patients and their healthcare providers before undergoing PSA testing.

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Introducing allergenic foods to babies

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• ‍‍Old practice: Parents used to wait before giving their babies foods like peanuts to avoid allergies.
• New practice: Research (such as LEAP and EAT studies) suggests that introducing these foods early might actually help prevent allergies.

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These are just some of the examples highlighting the dynamic nature of medical practice as it adapts to the evolving landscape of scientific evidence.

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As part of evidence-based medicine, medical professionals regularly reassess and update guidelines based on the most current research findings to ensure the best possible care for patients.

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