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an Economist Intelligence Unit business healthcare

About evidence-based medicine and evidology

Evidence-based medicine (EBM) is new. The digital revolution of the mid-1990s made EBM possible by digitising global research and making it searchable and accessible via the Internet.

EBM brings the tools of modern risk assessment into the world of healthcare for the first time. It allows you to mathematically determine the relative effectiveness of competing interventions for any health-related condition. By bringing odds ratios to healthcare EBM allows you to see what works and what doesn’t with a clarity and precision previously unavailable.

For example:

Question

Should I use steroid joint injections to relieve pain and reduce disability in people with chronic non-specific lower back pain?

Before EBM

Some experts and studies say that such injections are effective at relieving pain and reducing disability in people with chronic non-specific lower back pain. Other experts and studies say they are not.

With EBM:

No, you shouldn’t use them. Injecting vertebral facet joints with steroids does not reduce pain or disability in people with non-specific chronic low back pain (RR for reduced pain or improved function at 1 month: 0.89, 95% CI 0.65 to 1.21)

EBM brings confidence and peace of mind to decision making.  Evidence-based analysis aggregates, filters and synthesizes the entire universe of research about a given question into one odds-based answer. This allows you to be confident you are making decisions based on the best information available to us as a species.  It sounds like a grandiose claim, but it’s not.  If you’re not using EBM then necessarily you are basing decisions on opinion or individual studies, and these routinely turn out to have been wrong.  EBM is rigorous clinical due diligence – once it is done you can be confident in decisions based upon it moving forward.

EBM information builds consensus and engages clinicians.  EBM facilitates consensus building among different (and usually unaligned) stakeholder groups – notably clinicians, commissioners, managers, policy makers and patient groups. By providing the scientific bottom line about what works and what doesn’t, EBM ends debates about which treatment is the best option.  This frees stakeholders to move on from “What are we going to do?” to “How are we going to do it?” – arguably a more important conversation.

Evidology

Every now and again a new medical specialty emerges. In the early 1900s it was radiology. Today it is evidology. Radiology emerged as a separate, specialist discipline because clinicians did not have the time, tools or training to take and accurately interpret their own x-rays. Today it is clear that “getting evidence-based” is not something clinicians, patients, insurers and policy makers can do on top of their regular jobs. They, too, do not have the time, tools or training to do so. Producing high quality evidence-based analyses requires specific skills, resources and a dedicated focus. This is why Bazian believes the practice of evidence-based medicine is actually a new and emerging specialty called “evidology”. In the near future insurers, policy makers, clinicians and even individual patients will routinely work with evidologists to determine the scientific bottom line relating to their questions, issues and decisions. Bazian is working towards that day.

Ev·i·do·l·o·gy n.

A medical specialty that enables medical research to be incorporated systematically into clinical practice [Latin videre to discern, comprehend; evideri to appear plainly]