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Coming back to "real Evidence-Based Medicine": a call by Trisha Greenhalgh and colleagues

Trisha Greenhalgh

Trisha Greenhalgh

As a contribution to the debate between Evidence-Based Medicine (EBM) and Narrative Medicine, we propose the article “Evidence-Based Medicine: a movement in crisis?” written by Trisha Greenhalgh, Jeremy Howick, and Neal Maskrey, and published on BMJ. The article aims to be a call for a campaign in favor of what the authors call the “real EBM”: that one making the ethical care of the patient its first priority, demanding individualized evidence in a format that both clinicians and patients can understand, sharing decisions with patients, building on a strong doctor-patient relationship and on human aspects of care, and finally applying these principles at community level for evidence-based public health.
According to the authors, the call is necessary because – although EBM has had many benefits – it has also had some negative unintended consequences because of whom many supporters of EBM have argued that it is now facing a serious crisis: the evidence-based “quality mark” has been misappropriated by vested interests; the volume of evidence (especially clinical guidelines) has become unmanageable; statistically significant benefits may be marginal in clinical practice; inflexible rules and technology driven prompts may produce management-driven care; evidence-based guidelines often map poorly to complex multimorbidity.

Such problems have led to argue for the rejection of EBM as a failed model. On the contrary, Greenhalgh and colleagues argue for a return to EBM founding principles: they offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise, so that patients get optimal treatment.

To deliver this agenda, patients must demand better evidence – better presented, explained and applied in a more personalized way; clinical training must hone expert judgement and shared decision-making skills; producers of evidence summaries and guidelines must take account of who will use them; publishers must demand that studies meet usability and methodological standards; policy makers must resist the instrumental generation and use of “evidence” by vested interests. And finally, the research agenda must become broader and more interdisciplinary, and EBM stakeholders (patients, clinicians, policy makers, and so on) must work together.

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