Evidence-Based Medicine (EBM), means practicing of rational and scientific form of medicine. However, there has been some misunderstanding of the term in academic and especially public spheres. Hence this article.
Modern medicine, as is practiced today, is the product of centuries of scientific advancement. Unlike some other forms of medicine, allopathy does not claim its origin in the dictates of any God. It is men who have built the system brick by brick laying one verified concept over the other. Although we have not completely decoded ‘life’ yet, we have understood it up to cellular and genetic levels! Thereby, we have discovered both possibilities and limitations while continually pushing the boundary.
In all this process, how did the truth (or knowledge) reveal itself to us? Well, it did not. We had to search it amidst an enormous data that laid before us from time to time: the experimental data, clinical data, random occurrences, experiences, chance happenings, trials, studies, theses, theories, discussions, deliberations and what not. Simultaneous advancements in other fields like pure science, technology, politics, sociology and jurisprudence also galvanised the speed of medical advancement. Ironically, some unfortunate events like world-wars and epidemics also contributed rather immensely to medical field. It was a collective, co-ordinated and contiguous endeavour of entire human race across the globe and along generations to know itself and heal itself.
And there lied the trap! When the subject (humankind) is same as the object and also the interpreter of the study, how do you ensure objectivity in the process? How do we know that the truth is not being influenced by ‘human’ factors? The various incorrigible natures that make us human: inaccuracies, judgemental errors, biases, empathy, stereotyping, ego, greed etc along with various tendencies and traits would only ensure that we measure and interpret the data pertaining to human healing in varied ways. That would never allow the science to form in any solid way.
Hence, evidence-based medicine.
Recently, I happened to hear a lawyer remarking that doctors have now ‘resorted’ to evidence-based medicine! He mocked: “you bring me evidence; I give you medicine.” Perhaps he was referring to the defensive style of medical practice, asking for investigations to support our diagnosis and treatment. But that is NOT evidence-based medicine.
The ‘medicine’ in EBM is not the physical form of medicine that one consumes or gets pushed into the veins. It is the abstract-noun form of ‘medicine’-the medical practice. The ever-changing concepts of practicing ‘medicine’. And the ‘evidence’ is unlike the one that the lawyer produces in a court of law. Let me summarise EBM in general for you:
The largest possible data on a specific question in medicine is subject to the test of truth. One great means of arriving closer to truth is statistics. Because, mathematics is the language of truth as embraced by scientists from quantum physics to astronomy. While gathering and processing the said data, certain rules are adhered to. Minimising biases at different stages; methods to standardise the objects and the data itself for better comparability; identifying probability of chance occurances masquerading as natural patterns of occurance; extrapolation of the inference and its applicability to the rest of the world are some of the major tasks managed by statistics. This step condenses some sense out of a hitherto chaotic data. This mathematical sense is further given the much-needed human touch by a peer group. Discussions, interpretations, ethical implications and the philosophy around the specific issue starts taking shape. This then, becomes evidence-based medicine: the medical concept based on solid scientific evidence, backed by concerned practitioners. it still has to face the test of time to get established as a useful EBM in actual practice.
This EBM then stands apart from an individualistic or mass-propagated concept of medicine. The latter may be closer to truth or far away from it, with no means to tell the difference. One classic antonym of evidence-based medicine is ‘Eminence’-based medicine. The medicine that is dictated by an eminent proponent and followed blindly. History of medicine is rife with examples of concepts and methods that were all too popular at one period of time just because they were popular. Akin to certain celebrities who are famous for being famous! Once they were subjected to fact finding (read EBM), they lost credibility and are not in practice anymore.
So, next time you criticise EBM, be prepared to choose from the alternatives: Eminence-based medicine, mass-based medicine, God-based medicine or market-based medicine.
Why then is there scepticism about EBM? If you noticed, EBM had devised ways to address bias, comparability, validity applicability etc. For long, intention and deliberate false-representations were not prominent concerns in science. Even today, scientific reviewers and editors demand reproducibility of results more for utility in general than establishing credibility. The idea is: if it is not truth, it shall not stand the test of time anyway! As it always happens, this nobility has been misused especially lately. But not to the extent of disregarding EBM altogether.
Another important set back happened when market forces utilised EBM for their gains. But believe me, every major change in human history: be it expeditions, crusades, science and technology or conquest is shaped by market forces only! Period. Hence, it is futile to blame science for bending along the blow of market winds. Good news is that, markets can tweak only the direction of scientific research. Further truth in that direction can only be unearthed by nothing other than EBM. Else, what other realistic options do we have?
EBM is inevitable to practice medicine rightly. To abandon EBM altogether for its inevitable misuse is like the lawyer disregarding the constitution just because it is not followed in right spirit! And to protect the very reliability of EBM, especially from market-manipulations, a socialistic model of science needs to be developed.
Wait, what? A socialistic model of science! Well, that is for another article.