EBM

That stands for evidenced-based medicine.

EBM is the hallmark of what is considered to be good modern medicine. In an interesting turn of events, however, many members of the healthcare sphere are starting to challenge the notion that EBM should have the last say on how we treat patients.

Take acupuncture, for example. It is slowly, but surely, being incorporated into Western practices. Patients are coming back to their doctors and saying that the combination of prescription drugs and a visit to their acupuncturist is curing them of their ailments. I even know of physicians who are working to obtain certification in this technique. While acceptance of acupuncture is growing, looking back it seems kind of silly that it's taken this long to establish acupuncture as part of our treatment plans. Why, despite CENTURIES of documented positive outcomes with this treatment, did medicine drag its feet?

As a M.D., I can tell you there are several reasons, but today I want to focus on this idea that EBM is a two-edged sword. It makes sense that the doctor whose reputation is on the line would be hesitant to prescribe or promote something that hasn't be 'proven' yet. Likewise, medical schools tend to stick with traditional practices and have been hammering students with EBM in this day of malpractice and tenuous reimbursement. If all I got out of my didactic group sessions was one thing, it was "Randomised Control Trials" (RCT) are the be all, end all. (RCTs require stringent experimental setups comparing the drug/method in question with a 'control' that should remain unchanged, unaffected throughout the process.)

But are RCTs really the end of the line?

This topic is in line with that whole "If a tree falls in the forest and no one hears it. . ." saying. In this case, the 'tree' is any alternative therapy that has yet to be put to the test by rigorous experimentation. Without academic journals speaking to the power and stature of that tree, it will go unheard by many if not most physicians whether it works or not.

Put another way, that means that even if fairy dust were to fall from Neverland causing the lame to walk and even fly, it would still have a hard time finding its way on to our prescription pads without a good study behind it.

The tide is just starting to shift, though. Not only are more physicians not waiting around for the pharmaceutical company to roll out its next goodie, we're starting to see advocates for a change in how we process data. To highlight that, I'll wrap up this post with the following article:

Hilarious.

The objective of this study by Smith and Pell was to find out if there were any randomized control trials in support of parachute use. Turns out, no one had purposefully removed parachutes from some skydivers and documented how they fared in comparison with those who were fully equipped. . . As a tongue-in-cheek response, the authors then suggest that "the most radical protagonists of evidenced based medicine"  should participate in such a study and let us know how that turns out. Hee hee.