Careful consideration is needed in applying the evidence to your own clinical practice, as the best available evidence may come from patient populations with characteristics other than those of the patient in question. In addition, patients’ opinion regarding diagnostic tests or invasive treatments, as well as their tolerance to suffering and their risk assessment, should always be taken into consideration.
The Definitions for you
Let’s start with a definition, perhaps a little difficult at first contact; don’t stop here, we will be able to clarify it. Evidence-based medicine, as defined by David L. Sackett, with Archibald Cochrane among the “fathers” of EBM, is “the integration of the best evidence of clinical efficacy with the experience and skill of the physician and the values of the Patient”. We can express the same concept in another way: EBM is “the conscious, explicit and judicious use of the best biomedical evidence (i.e. evidence of efficacy) currently available, in order to make decisions for the care of the individual Patient”. For pharmaceutical value based selling this is important.
What the Examples Say
As you can see, the patient is the ‘center’ of evidence-based medicine and must know well why certain tests or treatments are recommended. Above all he must know what are the logic and the culture that “lie behind” the daily advice of his Diabetologist, not casual or subjective, but based on rigorous scientific research data applied “to measure” to each individual patient. Thus is possible the real therapeutic alliance that sees him as the protagonist of his treatment.
- Medicine has always been based (or should have been based) on these principles: today, however, there is such vast knowledge and such rigorous scientific methods that a movement of thought has been created that have tried to rationalize everything in order to provide the Patient with treatments for sure. Returning to our definition, the key concepts are three, Evidence-Based Medicine is the integration of the best ‘evidence of clinical efficacy’ with ‘physician’s experience and skill’ and ‘patient values’.
What is clinical efficacy evidence?
We all know that medical research is a vast field, which ranges from the knowledge of the meaning of single molecules in causing a disease to the study of the spread of a disease in a population and the biological or social reasons that determine it: all these forms of research is needed to build medical science.
- Clinical efficacy tests are the results of studies capable of demonstrating, with measurable scientific certainty that can be shared by others, that it is useful to perform a certain test or take a certain medicine. These studies are performed according to precise methods aimed at excluding the possibility of error.
Let’s take some examples
The Diabetologist tells that keeping blood sugar low is helpful in preventing diabetic retinopathy. Behind this claim are studies that have examined over a long period of time two groups of patients similar to each other at the beginning: one group treated in a traditional way, accepting higher blood sugar levels, and the other treated more aggressively, seeking to obtain lower blood sugar levels, close to normal. At the end of the study, diabetic retinopathy was much less common among patients who had been maintained at lower blood sugar levels.