by Jerome Whitney



For far too long, we as homeopaths have been beating ourselves with snatched up concepts, some of which we have taken on board from those who are intent on eliminating homeopathy from the face of the United Kingdom.

One of these adopted concepts is that Evidenced Based Medicine (EBM) is limited only to the evidence obtained via the 5 senses and Random Controlled Trials (RCT).  In so doing we have taken on board the disinformation and propaganda perpetuated by the ‘Cult of the RCT’.

However, when one begins to delve into the origins of Evidence Based Medicine it quickly becomes evident that the founder of EBM, in fact, articulated a holistic approach that included not merely systematic trials but the response of individual patients to clinical procedure.

The following is quoted from:

http://www.hsl.unc.edu/Services/Tutorials/ebm/whatis.htm

The most common definition of EBM is taken from Dr. David Sackett. EBM is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996)

EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

The evidence, by itself, does not make a decision for you, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBM is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders.

Evidence-based medicine requires new skills of the clinician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature.

The Steps in the EBM Process

The patient

1.  Start with the patient – a clinical problem or question arises out of the care of the patient.

The question

2.  Construct a well-built clinical question derived from the case.

The resource

3.  Select the appropriate resource(s) and conduct a search.

The evaluation

4.  Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice).

The patient

5.  Return to the patient – integrate that evidence with clinical expertise, patient preferences and apply it to practice.

Self-evaluation

6.  Evaluate your performance with this patient.

These individualised patient oriented steps are a far cry from applying the dehumanised statistical results of RCT drug trials upon arbitrarily selected disease labels. Rather EBM does not dictate the specific trial and experience-based methods for obtaining the evidence.

In fact the patient and her/his response included along with the practitioner's observation of the patient, as well as the practitioners experience, all become an integral collective in the treatment of the patient. Any valid systematically collected data that is relevant is also to be considered in the patient treatment picture that is being developed.

This approach blows wide open the simplistic fundamentalist dogma currently being spewed froth by the ‘Cult of the RCT’. Rather, what David Sackett has formulated is a holistic process with which homeopathy has now been conversant and applying for the past 200 years.

It is about time that we begin to acknowledge the real basis of Evidence Based Medicine and stop taking on board the snatched up stick of a limited definition and allow ourselves to be beaten by it.