CM. What is Evidence-based Medicine?


Today we introduce Questions and Answers, a new feature of CientMed that addresses key issues of current medical sciences. The author of this first note is Dr. Arturo Martí-Carvajal, a previous contributor to our journal, with longstanding experience in meta-analysis and systematic reviews. The short answer of this author to the above question is a combination of science and philosophy as summarized here,

Evidence-based medicine, as it follows, is the conscientious, explicit, and judicious use of current best evidence in making decisions about individual patients. Therefore, EBM’s praxis encompasses two components: a combination of medical expertise with the best available external clinical evidence from systematic research. Consequently, according to EBM’s concept, medical treatment decisions must be based on the best available evidence. From a philosophical point of view, the EBM’s paradigm can be considered as a modern dialogue between Aristotle and Hippocrates. Doubtless, EBM is also strongly related to Descartes’ expression to his mentor, Piere Marin Mersenne, in 1630, «Medicine based on infallible demonstrations.» Between Descartes’ and Sackett’s expressions, 366 years have passed, however, the foundation of EBM is nothing but the advent of Clinical Epidemiology.

Further on in his writing, Dr. Martí-Carvajal admonishes the reader with this paragraph that denotes his knowledge as a skilled clinical practitioner and prolific researcher of many disciplines of medical sciences. We hope that you will find the whole article useful as well as entertaining.

There are a series of pitfalls for the use of evidence in clinical practice. The massive amount of biomedical information exceeds the reading capacity of the interested parties. Undoubtedly, not everything that is published is accurate, which is regardless of the cause of the bias. The clinical practice is not homogeneous, because of the differences in health care for the same clinical entity. It can also be caused by a lack of confidence in the studies reported on the same nosologic issue. Also, most health interventions lack studies that support their use; and the intervention’s economic cost may be high. Consequently, a critical analysis of the studies that support the use of the interventions in daily clinical practice is required, because the validity of current knowledge can quickly lose that quality. Therefore, it is sensible to ask how can studies that answer the clinical question be detected, integrated, and synthesized? How can we determine what is valid or not?

Rafael Rangel-Aldao, Editor

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