Why Evidence-Based Medicine is Not Going Away, Despite Alleged Ban of the Term – December 20, 2017 – By Angie Drakulich
The scientific community has been incensed—as well as confused—by the past week’s [Dec 2017] alleged ban/unban of certain words by the Trump administration in connection with the US Centers for Disease Control and Prevention’s 2019 budget proposals.
Among other terms, “evidence-based” and “science-based” were called into question.
Some practitioners have scoffed at the terminology, especially after the 2016 CDC guidelines on prescribing opioids emerged, noting that the most effective way to treat a patient is through a case-by-case, personalized approach .
Individualized medicine may be especially pertinent when long-term, large population studies are lacking for certain complex, comorbid, lifelong, or rare diseases and conditions.
Practical Pain Management collected feedback from its editorial advisory board members.
This group of clinical, pharmacological, research, and academic professionals work day in and out in to assess, diagnose, and treat patients living with chronic pain conditions.
The following comments contribute to the conversation at stake.
Administrators and politicians think it [evidenc-based medicine] means physicians using diagnostic and management algorithms developed externally for the purpose of standardizing medicine and lowering its cost.
There it is: our government is trying to standardize our medical care to save money.
If it only takes a blood test and computer algorithms to process the results to determine the correct diagnosis and treatment of a patient, expensive doctors would no longer be needed for most care.
They are essentially trying to replace our primary care providers with fancy equipment and computers.
This is what I’ve also been saying all along: the practice of medicine can’t be “standardized” because the proper practice of medicine involves the examination of and determination of care for individuals, who differ greatly in their presentation and internal biological situation.
“Before I would be willing to develop a response to any attempt—political or otherwise – to sideline EBM, I would require a better understanding of the argument against EBM and the logic behind the attempt. I would also wish the opponent to better understand EBM.”
-I. Jon Russell, MD, PhD, ACR Master, Fibromyalgia Research and Consulting, Texas
“These expressions come and go. The National Science Foundation has to find homonymous expressions that relay the same meaning.
For someone like me who spent his childhood behind the Iron Curtain, this was a favorite task that people actually enjoyed doing to fight the communists.
So Dr. Sella implies that we are living during a time in American history where scientists must find clever expressions to describe phrases, like evidence-based medicine, in politically approved language.
Rules dictating what words cannot be used in federal documents is practically the definition of censorship.
The advent of the curtailing of freedoms in our country may give some room for thought to the people who looked down at those living under the Iron Curtain.”
-Gabe Sella, MD, MPH MSc, PhD, Ohio Valley Medical Center, Wyoming
The absurdity and wrongfulness of dictating what words can be used is an insult to science and our nation. If we don’t champion evidence-based or science-based medicine, we might as well return to the age of witchcraft, blood-letting, and snake-oil salesmen.”
-Don L. Goldenberg, MD, Oregon Health Services University, Oregon
“The lack of the use of evidence-based medicine is one of the many reasons for the travesty that is the CDC Guidelines. Failure to use evidence-based or scientifically based data to create guidelines or use them to write certain medical and scientifically based literature would, many times, reduce the work to anecdotal information, or even bobe-mayse (fairy tales) for those who care.”
-Gary W. Jay, MD, Neurology, University of North Carolina
“Interestingly, the ‘PharmacoMafia’ has to find evidence of only 5% above average placebo of 35% to claim a drug is ‘effective.’
No drug is 100% effective and virtually all produce complications called side effects. The bottom line is: What does effective mean? And what does evidence- or science-based mean?”
-Norman Shealy, MD, PhD, International Institute of Holistic Medicine, Missouri
I do believe that clinicians must use common sense and not always rely exclusively on evidence-based medicine in an effort to treat the individuality of each patient
To eliminate both in discussions and official documents propagates lawlessness to government and the clinicians that care for patients.
A case in point is the recent publication ‘Safety Concerns with the Centers for Disease Control Opioid Calculator’ (Fudin et al) which explains the Wild-Wild-West mentality that was allowed in the development of the controversial 2016 CDC guidelines on opioid prescribing, and the risk to patients from their non-evidence/non-science based online opioid conversion calculator.”
Safety concerns with the Centers for Disease Control opioid calculator – Free full-text PMC article
-Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP, Remitigate, New York; Western New England University College of Pharmacy; Albany College of Pharmacy and Health Sciences
“As a scientist, of course I am evidence- and scientifically based, but as a working clinician, I am much more open to the concept of new uses for older medications.
If we do consider ourselves as the pioneers of pain management, then we ought certainly do no harm, but we also owe our patients the best efforts, within our specialties and interests. And our strong desire is to help the ones in need.”
-John Claude Krusz, MD, PhD
Anodyne Headache, PainCare & Well-Being, Texas
As scientists and policymakers pave their way through the terminology of today, the most swaying impact comes down to the patient level and what treatment will provide them with the most safe, effective, long-term outcome.
When medicine no longer pursues that goal and is controlled by government policies instead of medical knowledge and experience, we are all in deep trouble.