Blog | Monday, September 22, 2014

Has the term 'evidence-based' lost its meaning?


During my career, evidence-based medicine has become a rallying cry for quality. Experts exhort us to use evidence to make better treatment and diagnostic decisions.

This movement’s founders had and have pure intentions. They champion a careful dispassionate analysis of data to answer important clinical questions. They critically evaluate the literature and work diligently to apply the data to the individual patient.

Unfortunately, theory too often trumps practice. Since the concept seems so pure and desirable, one might predict that some would use the term incorrectly. Of course they do. Claiming that a treatment is “evidence-based” makes it good.

Nietzsche apparently said, “There are no data, only interpretations.” Evidence-based medicine, while a great theory, too often falls apart in practice. How else can one explain the all too frequent guideline disagreements? One group views the evidence differently than another group.

Too many decision makers do not understand the concept of extrapolating beyond the data. As I often cite, the 4-hour pneumonia rule is the classic example, but likely so is tight control of diabetes and tight control of hypertension.

I personally believe that the term “evidence-based” has lost its cache. The idea is a good one, but in 2014 I fear that the term is overused and used inappropriately. I wish it still meant based on a dispassionate analysis of the evidence. It does not, so we should quit imagining that it does.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.