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I thought I would revisit this topic as it is a sore spot for me personally as a clinician that so few understand and practice it as it was originally intended. Great place to start is with the definition:
Evidence Based Medicine (EBM): "A systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values" Dr. David Sackett 1996
To put it more direct, it is the Clinician taking the best available research and filtering through it to identify useful points that, based on the clinician's experience and knowledge of the human body, can be applied to the individual patient in a way that is valuable to them. This then is the application of both Experimental Science (Randomized Clinical Trials for example) and Empirical Science (Current and Previous Observation in the real world).
What modern medicine has defined as EBM is only the application of Experimental Science noting that Empirical Science is biased. A deeper look at Experimental Science would reveal bias as well in the interpretation of these results and how they are used. By Physicians to over-simplify the disease process. By Healthcare Organizations to create Data they can then use to make decisions (typically financial) on. By Insurance and the Government to drive down spending. It can and should be useful to use the Experimental Science as a starting point and develop strategies based on it. It becomes problematic when you take these strategies and apply them to every disease and every person who comes through the door without the experience and knowledge of the provider. So "Clinical Prediction Rules", "Protocols" and "Population Health Strategies" are not all bad, but they fall short in the case of those patients whose presentation falls outside the parameters of the Experimental Research (Chronic Disease, Chronic Pain and ME/CFS as examples).
So in reality, for those cases that fall outside of the parameters of Experimental Research it is the Empirical Science and the collective knowledge of the provider(s) that becomes the driving force. It requires a keen knowledge of the body's systems and how they function, the best available knowledge of current theories on the cause and treatment of the disease, as well as the ability to correlate similar cases and treatment responses from other patients into the treatment program. This creates the support for "Off Label" use of medication and safe application of treatment protocols that insurances would likely determine are "Experimental".
Lastly it is important to note that the patient's values are included in the definition of EBM. What this means is that if the care provided does not add value (typically improvement or at least a better definition of what is wrong) then it is not EBM. It requires by definition that the patient should be a partner with the provider in the treatment process and should actively participate in choosing the form of treatment and engaging themselves in it.
So why talk about EBM in a ME/CFS forum? Because I believe it is the template for finding a cure or at least significant improvement in how we treat this disease (and many other chronic diseases). Also because the expertise and experience of many medical providers is being removed from the process of identifying and developing treatment for ME/CFS. AND because the patient's values are not being heard or considered in many cases.
Evidence Based Medicine (EBM): "A systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values" Dr. David Sackett 1996
To put it more direct, it is the Clinician taking the best available research and filtering through it to identify useful points that, based on the clinician's experience and knowledge of the human body, can be applied to the individual patient in a way that is valuable to them. This then is the application of both Experimental Science (Randomized Clinical Trials for example) and Empirical Science (Current and Previous Observation in the real world).
What modern medicine has defined as EBM is only the application of Experimental Science noting that Empirical Science is biased. A deeper look at Experimental Science would reveal bias as well in the interpretation of these results and how they are used. By Physicians to over-simplify the disease process. By Healthcare Organizations to create Data they can then use to make decisions (typically financial) on. By Insurance and the Government to drive down spending. It can and should be useful to use the Experimental Science as a starting point and develop strategies based on it. It becomes problematic when you take these strategies and apply them to every disease and every person who comes through the door without the experience and knowledge of the provider. So "Clinical Prediction Rules", "Protocols" and "Population Health Strategies" are not all bad, but they fall short in the case of those patients whose presentation falls outside the parameters of the Experimental Research (Chronic Disease, Chronic Pain and ME/CFS as examples).
So in reality, for those cases that fall outside of the parameters of Experimental Research it is the Empirical Science and the collective knowledge of the provider(s) that becomes the driving force. It requires a keen knowledge of the body's systems and how they function, the best available knowledge of current theories on the cause and treatment of the disease, as well as the ability to correlate similar cases and treatment responses from other patients into the treatment program. This creates the support for "Off Label" use of medication and safe application of treatment protocols that insurances would likely determine are "Experimental".
Lastly it is important to note that the patient's values are included in the definition of EBM. What this means is that if the care provided does not add value (typically improvement or at least a better definition of what is wrong) then it is not EBM. It requires by definition that the patient should be a partner with the provider in the treatment process and should actively participate in choosing the form of treatment and engaging themselves in it.
So why talk about EBM in a ME/CFS forum? Because I believe it is the template for finding a cure or at least significant improvement in how we treat this disease (and many other chronic diseases). Also because the expertise and experience of many medical providers is being removed from the process of identifying and developing treatment for ME/CFS. AND because the patient's values are not being heard or considered in many cases.