Clinical

Evidence-Based Medicine

Does the knowledge gained from a clinical trial answer the question of what is best for a patient?

Discuss this in terms of the importance of good clinical design and the ultimate decision-making process of an individual physician.

Defined as “an optimal method for developing and describing population-based medical evidence,” evidence based medicine (EBM) “attempts to describe a clinical practice centered on evidence derived from clinical studies,” EBM has been denoted as the gold standard for clinical practice [1]. Despite the validity of EBM, it is crucial that we consider the limitations when it comes to application.

To begin with, despite the increasing numbers of well-designed clinical trials paired with systematic reviews, EBM cannot bridge the gap between clinical research and practice. Source validity is a big issue in the clinical field, for the companies that would gain the most from a drug’s “success” funds the trials that investigates them, potentially introducing bias that threatens the validity of the data itself. For rare diseases that affect small groups of people rarely have enough clinical data to rely upon. Most importantly, regardless of how many trials are conducted on however many people, every circumstance and variable for each patient cannot be accounted for. Thus posed the question of if the knowledge gained from a clinical trial answer the question for what is best for a patient- I would argue that while, in some cases, with a robust arsenal of evidence, it is plausible, most of the time it would be hard to apply a population study to an individual.

As methodologies pertaining to EBM continue to develop, population statistics are gaining increasing significance in medical decision making. Considering the risks above, good clinical design and careful integration into clinical practice is crucial to lessen the dangers. The physician takes a large role in this integration process. They must pair other bases of knowledge with clinically relevant evidence when evaluating patients, for they must take into consideration a wide variety of factors that is unique to the patient. Evidence can never directly dictate care or empathy, and the evidence cannot dictate when it is best to ignore evidence. Population statistics leaves these questions unanswered, meaning keeping the focus of clinical practice on the individual will remain the job of a physician. 

Sources

[1] https://pubmed.ncbi.nlm.nih.gov/9883197/

[2] https://journalofethics.ama-assn.org/article/limitations-evidence-based-medicine-applying-population-based-recommendations-individual-patients/2011-01 [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/

Categories: Clinical