A paper published November 4, 1992 by Guyatt et al called “Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine” with the stated intent of Evidence-Based Medicine (EBM) being “to shift the emphasis in clinical decision making from “intuition, unsystematic clinical experience, and pathophysiologic rationale” to scientific, clinically relevant research.” And so began the EBM movement.
Through the years EBM displaced “the doctor-patient unit as the ultimate decision-making authority”. EBM was quickly “hijaked” by industry to ” serve agendas different from what it originally aimed for.” To promote industry products through “clinical practice guidelines.” The guidelines are determined by a “consensus of “experts” who are often captured by industry funding, which “ironically, many guideline recommendations are based on low quality, or no evidence,” and fall short of trustworthy standards.
EBM “relies heavily on studies of large populations and therefore statistics, which are inherently unreliable and easy to manipulate“, yet these population level studies are used to “dictate” a one-size fits all treatment – ignoring clinical experience and individual patient needs. [2]
A cornerstone of EBM is the hierarchical system of classifying evidence known as the levels of evidence, where randomized controlled trials (RCT) are considered the highest level and case series or expert opinions are the lowest level. [1]
He who controls the “evidence” controls “the science” and then in turn “influences” third party “health officials” to formulate clinical practice guidelines (protocols) that hospital administrators then force their doctors to follow! [3, 4, 5]
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