Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations.
When evaluating study results from medical journals and nutrition journals we have to take into account the evidence based medicine approach. EBM as an approach requires that we consider deeply the epistemological strength which is based on the quality of the research. Well designed well conducted research include meta-analyses, systematic reviews, and the gold standard randomized controlled trials. For this reason if we use an ICO to fund research into anti-aging or life extension then we must make sure that the design of the study conducted is of the highest quality so that in the end the result can yield strong recommendations.
Question: Does a plant based diet reverse arteriosclerosis?
Based on EBM we would have to say only weak recommendation because while there is evidence of success the size of the studies aren't large enough and the mechanism behind the success isn't well elucidated. For example we do have evidence that certain populations of humans do not have or develop arteriosclerosis and that these populations also tend to have low LDL. So we in the very least can see low LDL levels are being correlated with low risk of arteriosclerosis. Is a plant based diet alone enough to cause LDL levels to be that low and does it matter when a person goes on the plant based diet? Is it most effective if a young person goes on a plant based diet as an infant in order to lower risks in adulthood? Is milk officially bad for children because it could contribute to arteriosclerosis?
EBM can help us at least to determine whether or not a new treatment has strong evidence behind it.
References
- https://en.wikipedia.org/wiki/Evidence-based_medicine
- https://steemit.com/health/@dana-edwards/elderly-persons-with-high-ldl-live-longer-ldl-is-inversely-associated-with-mortality-in-the-elderly-over-60
- https://steemit.com/ethereum/@dana-edwards/can-an-ethereum-ico-fund-a-randomized-control-trial-for-http-www-invasivecardiology-com-news-cyclodextrin-dissolves-cholesterol
EBM is widely implemented in all decision making concerning health care. EBM is mostly based on metanalysis from studies that qualify for inclusion. Inclusion criteria may wary. However, you have not mention that EBM maybe fundamentally flawed because almost all paper that show not significance or negative date do not get published. The Cochrane library (http://www.cochrane.org) is the most trusted source of recommendations. Heurestics and logical thinking (mechanistic) can often yield much faster, cheaper and safer answer to biological questions than EBM based on metaanalysis imho.
Even Cochrane has some flaws to their analytics of data. An example of that is their approach to proning patients with severe ARDS where they stated that there was no convincing evidence of benefit. Those people have never been at the bedside nor really interpreted the PROSEVA trial. I know empiric data is the worst, but PROSEVA showed a clear benefit. The studies prior to that didn't have the same methods. Either way, I'm going to end my rant stating that I LOVE EBM but there are caveats. Even worse so, there are so many things that just cannot be studied due to ethical issues.
i have learned from your post that Health care is majorly based on EBM now a days. very informative for me. thanks
This comment has received a 0.05 % upvote from @booster thanks to: @qasimwaqar.
A lot of it is, but you'd be surprised how many things clinicians do where there is no data, nor could we compile data because of ethical issues. For example, we do not know what is the optimal timing for providing patients with epinephrine when they are in cardiac arrest. We give 1mg every 3-5 minutes but there is NO data whatsoever stating that the interval and dose is appropriate. That being said, my practice is as evidence based as it could possibly be.
Very good post @dana-edwards . Evidence-based medicine should be implemented in our society especially in developing world where fake drugs are common. However all stakeholders have to help to make it happen. Thanks for sharing.
agreed, the world has to look at the way food and disease are correlated a lot more seriously! big business gets in the way and we have to put a stop to this chaos!
Good point
Your blog is about medicines and health
I am lucky to find you in community and now I'm keeping an eye on your future post for more healthy thoughts and valuable research .
Started following you @dana-edwards
Hey! Really intriguing post. Even though I see EBM as a positive approach which can greatly benefit the medical society, it has also been abused by certain "vested interests" in my opinion. Several companies in the pharmaceutical field have conducted their research in a manipulative way to be able to describe their treatments as having strong epistemological strength. They do this, for instance, by setting test-subject inclusion criteria in such a way that they will only get subjects that will respond positively to their treatment. So, I think EBM does have a strong and positive value but not all studies should be blindly trusted if they have good EBM results! Have a nice day:) link to a good article: http://www.bmj.com/content/348/bmj.g3725
Agreed. But sometimes, without the backing of the pharmaceutical company, the study drug cannot be obtained by the researchers. It's a very unfortunate scenario.
This is exactly what we need now , a change that will help human beings make better choices and live longer , science is changing and humans should adapt to this as well
I don't think we have in Romania EBM
There's definitely EBM in Romania. You may have some limitations with regards to access of drugs/technology, but giving someone an aspirin a day for stroke or heart attack prevention is EBM.
But we still need to check whether the diet plays a role or it is genetically programmed, and the diet will not help.
Nice post ...my mom is doctor she read ur post .and appreciated it ..thanks man
I personally found this post to be interesting.
However I also feel that part of the message may have been lost by virtue of the level of language used. It is not incorrect but a lay person such as myself did need to put more effort into peeling away layers of lingo bark in search of the sweet sap that one trusted was beneath.
That being said, Evidence-Based Medicine does in principle seem like a logical way to go - and I would rather have hoped that much more within medicine (than unspokenly implied here) were based upon such.
It inspires confidence to believe that the medicine or treatment that one is prescribed is upon the basis of a foundation of tried-and-true knowledge rather than upon a hedged bet that may be qualified, but is also partially a roll of the dice.
Perhaps I should clarify that I am personally a little skeptical of the field of medicine as we know it and hence my interpretations are thus-shaded. Thank you for sharing this information.
Not only a diet can affect the risk of atherosclerosis, but it is also affected by stress levels, alcohol consumption, physical activity.
My friend, who is a kind of bodybuilder, bought some fat-burning pills. There was information on the box. It suggested to drink at least 2 liters of water daily and run (or walk) at least 3 miles to increase the effect and reduce possible indispositions. In this case, I suppose that any can become slim without these pills.
It seems to me that EBM approach can help in the diagnosis, but solveting of the problem should be tailor-made.
Well explained.
It is in theory useful. Wouldn't bringing some clarity to a complex problem solving field help?
In practice it becomes very complicated. Physicians end up faced with all sorts of variable recommendations. So, if I have a IIb level of recommendation -- should I give that medication or not? Actually -- no one knows. It's a guess.
I'm not convinced that it really solves any problems. And the consequence of the EBM model is that the system has to deal with best practice initiatives that lag the research, and the decisions about what actions to mandate are made by a very few people and the system then enforces those actions in a very arrogant and condescending way, as if doctors who practice differently are backwards and ill informed hacks.
For example -- sepsis has gotten a lot of attention in the medical system over the last 15 years. Back then, one group of docs from one hospital were doing research about massive infusions of fluids through IVs to treat the low blood pressures that came with bad infections. They thought it helped, and eventually their research got enough attention that it was included in the new model of centralized medical protocols being spread throughout the system.
This new model is based on the idea of evidence based medicine and big data, with the idea being that by crunching large amounts of data or summarizing the aggregate of many different studies, you can figure out the single best approach to a problem, with the idea being that everyone should then do it that way. CMS (the medicare system) started to roll out specific treatments for specific medical conditions, including guidelines about how quickly those treatments had to be started. They tracked this data, and if you didn't treat enough people the way they said to, you would be penalized financially.
So the current state of affairs is that anyone with a specific combination of physical exam and/or lab findings to suggest sepsis gets large amounts of IV fluids. But this often causes patients to go into congestive heart failure. And meanwhile, no one has been able to replicate those initial studies that suggested large amounts of fluids were a good idea, and the current state of research suggests that it doesn't help at all. Plus, the criteria for sepsis decided upon by CMS wasn't the criteria for sepsis used in the initial Detroit studies.
The consequence of all of this is that the system spends a lot of time and money doing something that may, in all likelihood, cause more harm than good.
As far as I'm concerned, the system is grappling with the fact that there is no ideal way to treat a problem in a complex, self adjusting system. There are a few "fixes" that are no brainers -- I don't see anyone volunteering to be part of a double blind placebo controlled experiment on the efficacy of parachutes, for example.
The system didn't need big data to help it figure out that insulin was a good idea for diabetics. Or that IV fluids helps if you are dehydrated. Or that reducing joint dislocations is a good idea. But once you have picked that low hanging fruit, what remains isn't unclear because we aren't crunching large enough data sets, but because the very nature of it is too variable to be precise.
EBM is an attempt to provide the illusion of clarity for something that is by nature complex and unclear, and then to force the conclusion of the politicized health officials onto the rest of the system as if it is clear. I'm not sure that is a good thing.
In India all the ayurvedic medicines are evidence based. ( Ayurvedic - see google search )
When so many health articles on Steemit focus on terrible studies or draw conclusions on human health from studies of cells in tissue culture, it is great to see a simple and straightforward article promoting the value of high quality evidence. Thank you!