Evidence-Based Medicine or Faith-Based Medicine?


December 10, 2004

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I was recently contacted by an American doctor who asked for some good references on evidence-based medicine (EBM) to help him prepare for a debate with another physician who was opposed to EBM. After recovering from the shock that some 2004 doctor would take the opposing position, I offered him what I thought were good sources, and decided to try to make a succinct case for EBM.

Some years ago, the US Preventive Services Task Force[1,2] determined the hierarchy of quality of evidence to support interventions, such as:

  1. At least 1 properly randomized, controlled trial;

  2. Well-designed, controlled trials without randomization;

  3. Well-designed, cohort or case-control analytic studies;

  4. Multiple time series with or without the intervention;

  5. Dramatic results in uncontrolled experiments; and

  6. Opinions of experts or committees, clinical experiences, and descriptive studies.

Thus, the randomized, controlled clinical trial with blinding and sufficient numbers to have statistical power became the gold standard. Recognizing that not all interventions have been properly studied but that physicians must make clinical decisions anyway, David Sackett[3] is credited with having defined EBM as the "integration of best research evidence with clinical expertise and patient values."

I consider the near opposite of pure EBM to be pure FBM -- faith-based medicine. St. Paul defined faith as "the substance of things hoped for, the evidence of things unseen.[4]" This was OK for medicine in the first century AD, but in 2004, when there is evidence, I choose it as the basis for my care. That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed.

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