Once you have been diagnosed with a disease or condition, and you've taken the steps to determine that your diagnosis is correct, your doctor will begin making recommendations for your treatment. Depending on what your diagnosis is, your doctor may refer to evidence-based medicine to make those recommendations.
What Is Evidence-Based Medicine (EBM)?
Most diseases and conditions can be treated in more than one way, whether the goal is to cure the problem, or simply treat the symptoms. When your doctor explains the treatment choices you have, she will often be able to tell you which one(s) are known to work the best, and what side effects you may experience if you choose that treatment. She may have that knowledge because she is aware of evidence accumulated through experiments and clinical trials on patients who have already tried that treatment.
Knowledge developed through those trials and experiments is called "evidence-based medicine." Using scientific methods, researchers have determined that the results (evidence) demonstrates that more patients with that set of health and human conditions benefit from that treatment, and that the benefits outweigh the risks and side effects of that treatment.
The first use of the term "evidence-based" for treatments was used in the early 1990s. Before treatments were evidence-based, doctors relied more on history, their education, conversations with other doctors and their own sense to make treatment suggestions to their patients. Until scientific research demonstrated a treatment was beneficial, it might have been considered anecdotally to be effective, but there was no real scientific proof that the benefits outweighed the risks or that more patients benefited than didn't benefit from its use. Even today, many doctors will weigh the evidence against knowledge they have gained in other ways before they make recommendations to their patients.
Why Is Evidence-Based Medicine Important to Patients?
When you are diagnosed with any medical problem that requires treatment, especially a chronic disease like diabetes or a potentially life-ending disease like cancer, you will want to know that the treatment you choose has the best chance of curing you, or helping you manage the problem with the least negative impact on your lifestyle.
You will also want to know that the treatment reflects your values. For example, if you have been diagnosed with a disease that could be treated with a drug that would have a negative impact your quality of life but keep you alive longer, or a second drug that would keep you more comfortable even though your life might be shorter, then you and your doctor could refer to the evidence to decide which was the better choice for you.
When your doctor offers you a treatment that is evidence-based, he should be able to tell you how successful the evidence showed that treatment to be. For instance, the doctor may be able to tell you that 75% of the patients who took a tested drug for the same medical symptoms you have, were cured by taking that drug, and that may be a higher percentage than any other drug tested for your symptoms. In that case, the evidence shows that the drug your doctor wants to prescribe for you may be the better one for you to try.
Are Evidence-Based Treatments Always a Patient's Best Choice?
There is no simple answer to this question. In fact, there are a number of controversies that surround the use of evidence-based medicine.
Those controversies stem from three points:
- The evidence is gathered using groups of people, not individuals. Individuals do not always react the way the majority in the group may have reacted to any given treatment.
- Not all patients have the same set of values.
- There may be built in biases in the way the experiments are designed.
Smart patients understand that the ultimate choices for treatment are theirs. They partner with their doctors to choose the treatment that fits best with their goals and their values. In some cases, evidence-based treatments will be their best choices. In others, even the evidence won't make the choice obvious.
Understanding what evidence-based medicine is, how the experiments and clinical trials are conducted, and the questions and controversies that surround this approach, will make it easier to choose the treatment you prefer, and may make it more likely you will adhere to the choice you make.