From Medscape General Medicine™
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Evidence-Based Medicine or Faith-Based Medicine?
George D. Lundberg, MD
I was recently contacted by an American doctor who asked for some good references on evidence-based medicine (EBM) to help him prepare for a debate with another physician who was opposed to EBM. After recovering from the shock that some 2004 doctor would take the opposing position, I offered him what I thought were good sources, and decided to try to make a succinct case for EBM.
Some years ago, the US Preventive Services Task Force[1,2] determined the hierarchy of quality of evidence to support interventions, such as:
- 1. At least 1 properly randomized, controlled trial;
- 2. Well-designed, controlled trials without randomization;
- 3. Well-designed, cohort or case-control analytic studies;
- 4. Multiple time series with or without the intervention;
- 5. Dramatic results in uncontrolled experiments; and
- 6. Opinions of experts or committees, clinical experiences, and descriptive studies.
Thus, the randomized, controlled clinical trial with blinding and sufficient numbers to have statistical power became the gold standard. Recognizing that not all interventions have been properly studied but that physicians must make clinical decisions anyway, David Sackett is credited with having defined EBM as the "integration of best research evidence with clinical expertise and patient values."
I consider the near opposite of pure EBM to be pure FBM -- faith-based medicine. St. Paul defined faith as "the substance of things hoped for, the evidence of things unseen." This was OK for medicine in the first century AD, but in 2004, when there is evidence, I choose it as the basis for my care. That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed.
Readers are encouraged to respond for the editor's eye only or for consideration for publication via email: email@example.com.
1. Lawrence RS, Mickalide AD. Preventive services in clinical practice: designing the periodic health examination. JAMA. 1987;257:2205-2207.
2. Fontanarosa PB, Lundberg GD. Alternative medicine meets science. JAMA. 1998;280:1618-1619.
3. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. New York: Churchill Livingstone; 2000.
4. Holy Bible, New Testament. St. Paul; Hebrews 11:1.
George D. Lundberg, MD, Editor-in-Chief, Medscape General Medicine
Disclosure: George D. Lundberg, MD, is an employee of WebMD.
Medscape General Medicine 6(4), 2004. © 2004 Medscape
(used here by permission)
Here is a most significant quote from Dr. Lundberg:
"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues-namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy."
- Fontanarosa P.B., and Lundberg G.D. "Alternative medicine meets science" JAMA. 1998; 280: 1618-1619. (for more quotes)
Dr. Lundberg has great depth of understanding when it comes to these issues, and the medical community would do well to heed his admonitions.