EVIDENCE-BASED? CAVEAT EMPTOR II!. Presented to the NAMI Symposium: “What Do We Mean By Evidence-based Practices?” by Bryan R. Luce, Ph.D., MBA The MEDTAP Institute at UBC Monday, June 20 2005 Austin, Texas. Today, being evidence-based is “de rigueur”.
Presented to the NAMI Symposium: “What Do We Mean By Evidence-based Practices?”
Bryan R. Luce, Ph.D., MBA
The MEDTAP Institute at UBC
Monday, June 20 2005
Earl P. Steinberg, MD
Bryan R. Luce, Ph.D.
January, February 2005
Available evidence may not be applicable to decision at hand
Countering cookbook charge, Sackett et al added: “The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research [and] individual patients’ predicaments, rights and preferences in making clinical decisions about their care”.
*Sackett et al., EBM, What it is and what it isn’t. 1996, BMJ
Sackett et al sought to expand the concept of EBM to include clinical judgment and patient values. This could (and probably should) include real world clinical practice issues such as convenience, adherence factors, even economic effects as they may pertain to patient adherence.
Result: EBM for individual decision-making no longer prisoner of RCT; also, is a much less precise process & concept.
Steinberg, Luce, 2005
“The conscientious, explicit and judicious use of current best evidence in making health policy decisions affecting groups of patients.”
But this begs the question, do we care about efficacy, effectiveness or cost-effectiveness?
My answer: Not Efficacy! Thus….
“The conscientious, explicit and judicious use of current best evidence in making health policy decisions affecting groups of patients. The practice of ‘EBG’ means integrating evidence from real world practice with the best available external (RCT) clinical evidence from systematic research. EBG may or may not include economic evaluation.”
“A summary of the medical literature that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.”
Sackett, et al. 2001
“Best” evidence should include or consider:
“…an imprecise estimate of the right concept is superior to a precise estimate of a wrong concept” (Mishan, 1972)
To put it another way…