Article review: “Evidence-based medicine: a movement in crisis?” by Greenhalgh et al (2014)

Article review: “Evidence-based medicine: a movement in crisis?” by Greenhalgh et al (2014)

If you need reminding what Evidence Based Practice (EBP) is, check here.

Not sure what Trish was up to but this article is printed in really small font and I had to zoom to 170% in order to be able to read it.

detective-otter

Zoom activated, I could now tell the article discusses some limitations of EBP, and the authors argue that although EBP has many benefits it has created some unintended negatives as well, which they describe as:

Drug companies controlling the research agenda, meaning evidence base is biassed according to their vested interests. Examples include fiddling inclusion criteria to make it likely people who will create desired results will participate, and only publishing positive results.

Volume of evidence has become unmanageable. We’ve all done a CINAHL search and returned 1,062 results. You don’t see how you can narrow your search terms anymore and you certainly can’t read all the abstracts…

Benefits identified as statistically significant may actually provide negligible  difference to patients in real life situations. Especially when research is carried out poorly, eg small sample size or drug company fiddling as mentioned above, the efficacy of treatment is falsely inflated for what it would actually be on a real population.

Inflexible rules risk healthcare becoming management-driven (following technical instruction) rather than client-centred (using clinical expertise). Eg creating protocols or checklists from EBP and then only following these in patient care. Like the QOF, where GPs get money for achieving health targets- Greenhalgh suggests that patients are monitored and provided check-box medication if they meet the QOF criteria, without consultation about their individual circumstances (client-centred care). This is a point Cohen & Hersh (2004)  agree with. O’Halloran et al (2010) follow on by saying that the technical guidelines produced by EBP stifle creativity.

Evidence available for individual conditions and not for co-morbidity, making it difficult to find evidence for patients with multiple diagnoses.  An aging population plus better management of chronic disease means more people have multiple conditions, which research studies don’t cover, removing individualised patient care.

 

Greenhalgh et al (2014) suggest overcoming these negatives by providing individualised care taking the context and even professional creativity into account. Patient advocacy groups should dictate areas of research more than companies. Peer-reviewed publishers should up their standards for article inclusion, and information should be disseminated in more user-friendly ways/methods (like infographics/via YouTube).

 

Note: apparently comorbidity is more than one illness in a person, and multimorbidity is more than two illnesses in the same person.

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Source:

Cohen AM and Hersh WR (2004) Criticisms of Evidence–Based Medicine. Evidence-based Cardiovascular Medicine 8(3): 197–198.
Greenhalgh T, Howick J, Maskrey N and for the Evidence Based Medicine Renaissance Group (2014) Evidence based medicine: a movement in crisis? BMJ 348(jun13 4): g3725–g3725. Available at: http://www.bmj.com/content/bmj/348/bmj.g3725.full.pdf [Accessed on 03.05.2017]
O’Halloran P, Porter S and Blackwood B (2010) Evidence based practice and its critics: what is a nurse manager to do? Journal of Nursing Management 18(1): 90–95.
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