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Abstract
The concept of evidence-based medicine was launched in 1991 as a new paradigm to inform medical practice and has risen to be regarded as the gold standard. It rapidly gained the attention of medics, health service managers and the general media as it presented a means to improve efficiency and effectiveness of service delivery. Despite its stunning success in capturing the health agenda, the campaign that launched evidence-based medicine has also attracted criticism, particularly from clinicians and philosophers concerned about its selective views of knowledge and evidence, and for its denigration of reasoning, clinical experience and judgement.Evidence-Based Medicine traces this movement from its launch to its meteoric rise, examining what it has done for healthcare and medicine in the context of changes in science policy and the long-running criticism held against the movement for its inherent weaknesses.As evidence-based medicine will remain an important feature of healthcare in the decades to come, this book is perfect for healthcare professionals, medical scientists, health service managers and public health experts looking for a critical examination of the topic.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Contents | ix | ||
| Preface | vii | ||
| Chapter 1 The Origins of Evidence-Based Medicine | 1 | ||
| EBM: Brand New or New Branding? | 1 | ||
| EBM: The McMaster Model | 3 | ||
| Efforts to Build Medicine Based on Evidence from the 18th Century | 9 | ||
| Summary | 14 | ||
| References | 15 | ||
| Chapter 2 Evidence-Based Medicine in the UK | 19 | ||
| Thomas McKeown | 19 | ||
| Archie Cochrane | 21 | ||
| Summary | 32 | ||
| References | 33 | ||
| Chapter 3 The Cochrane Collaboration | 37 | ||
| Funding | 39 | ||
| Future Challenges | 41 | ||
| Mission Creep | 43 | ||
| Efficiency | 43 | ||
| Science or Market Research? | 45 | ||
| Is it Science? | 46 | ||
| The Tamiflu Saga | 46 | ||
| Summary | 53 | ||
| References | 54 | ||
| Chapter 4 Evidence-Based Medicine and the Evolution of Health Related Research | 59 | ||
| Historical Context | 59 | ||
| The Haldane Principle | 60 | ||
| Medical Research Council | 62 | ||
| Medical Research | 63 | ||
| The National Health Service (NHS) | 65 | ||
| Medical Progress, Increasing Complexity and Costs | 66 | ||
| Health Services Research | 68 | ||
| Medical Research and Health Policy | 69 | ||
| The Rothschild Report | 70 | ||
| Rothschild in Reverse | 73 | ||
| NHS Reforms | 75 | ||
| House of Lords Select Committee on Science and Technology | 78 | ||
| National Health Research Authority (NHRA) | 79 | ||
| The Rise of Health Services Research | 80 | ||
| The NHS R&D Programme and the Founding of EBM in the UK | 82 | ||
| EBM | 84 | ||
| Medical Research | 86 | ||
| Conclusions | 87 | ||
| References | 89 | ||
| Chapter 5 Hypothesis, Evidence, Knowledge and Reasoning in Medicine: Certainty and Uncertainty | 95 | ||
| Evidence in Medicine | 97 | ||
| Prophylactic Use of Anti-Flu Drugs Controversy | 98 | ||
| Best Evidence in Medicine | 99 | ||
| Hierarchies of Evidence — A Failed Enterprise | 100 | ||
| Evidence and Interpretation | 101 | ||
| EBM and Myth-Making Rhetoric | 103 | ||
| Clinical Judgement versus Mechanical Rules | 105 | ||
| Mechanical Rules and Public Health Screening | 105 | ||
| Diagnostic Criteria | 108 | ||
| Duckett Jones Diagnostic Criteria for Rheumatic Fever | 109 | ||
| The Role of Evidence in Clinical Judgement | 110 | ||
| Expert Opinion and Clinical Judgement | 110 | ||
| Mechanistic Reasoning and EBM | 115 | ||
| Mechanistic Reasoning and Clinical Medicine | 117 | ||
| Conclusions | 119 | ||
| References | 120 | ||
| Chapter 6 Evidenced-Based Medicine and Medical Science | 125 | ||
| Medical Science and Clinical Practice are Intimately Related and Interdependent | 125 | ||
| EBM: Impact on Science | 127 | ||
| Medical Science: Data Sets versus Hypothesis and Reasoning | 129 | ||
| John Snow’s Discovery of Water Borne Cholera: Truth is Richer than Myth | 130 | ||
| Data without Reason becomes a Fog | 135 | ||
| The Problem of Antibiotic Resistance | 135 | ||
| Contrasting US and UK Approaches | 136 | ||
| How Penicillin was Discovered and Developed | 138 | ||
| Meeting the Challenge; Then and Now | 140 | ||
| Problems Seeking Solutions versus Solutions Seeking Problems | 143 | ||
| Conclusions | 146 | ||
| References | 147 | ||
| Chapter 7 Impact of Evidence-Based Medicine on Clinical Practice: Achievements and Limitations | 151 | ||
| EBM: Impact of Medicine | 152 | ||
| Clinical Guidelines | 154 | ||
| National Institute for Clinical Excellence (NICE) | 156 | ||
| Impact of Guidelines in Clinical Practice | 157 | ||
| Wider Impact of EBM | 158 | ||
| Full Disclosure of Clinical Trials | 158 | ||
| Overdiagnosis in Medicine | 159 | ||
| EBM: Unintended Consequences | 161 | ||
| What Evidence? | 162 | ||
| Value of Evidence and Evidence of Value | 162 | ||
| Bias of the Easily Measurable | 164 | ||
| “Real EBM” — A New Iteration of EBM? | 165 | ||
| Conclusions | 167 | ||
| References | 168 | ||
| Chapter 8 Evidence-Based Medicine and Medical Professionalism | 173 | ||
| Evidence-Based Medicine (EBM) | 176 | ||
| Health Policy and Management | 177 | ||
| The Royal College of Physicians (RCP) | 178 | ||
| General Medical Council | 181 | ||
| Professionalism in Practice | 183 | ||
| EBM and Medical Professionalism | 183 | ||
| Evidence and Judgement | 183 | ||
| Guidelines, Rules and Clinical Judgement | 184 | ||
| Medical Professionalism in the Health Service | 185 | ||
| Clinical and Non-Clinical Professionalism and the Role of EBM | 186 | ||
| Medical Professionalism and Leadership | 187 | ||
| Conclusions | 191 | ||
| References | 193 | ||
| Chapter 9 The Future of Evidence-Based Medicine | 197 | ||
| Medicine is about more than EBM | 198 | ||
| EBM and Conflicting Professional Values | 198 | ||
| EBM Must be about more than Medicines | 200 | ||
| Independent EBM | 202 | ||
| EBM and Medical Science | 203 | ||
| EBM Replacing Clinical Science | 203 | ||
| EBM and the Language of Medicine | 205 | ||
| Overdiagnosis: Conceals more than it Reveals | 206 | ||
| Distortion of Meaning | 207 | ||
| Conclusions | 211 | ||
| References | 212 | ||
| Index | 215 |