EBCP Editorial - SPINE Volume 36, Number 17, pp E1121E1125...

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Spine www.spinejournal.com E1121 E DITORIAL SPINE Volume 36, Number 17, pp E1121–E1125 ©2011, Lippincott Williams & Wilkins Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. The Pros and Cons of Evidence-Based Medicine Peter Croft , MD * Antti Malmivaara , MD † and Maurits van Tulder , PhD ‡ I n a debate “Evidence Based Medicine: Saviour or Pariah” at the 9th International Forum on Low Back Pain Re- search in Primary Care , evidence-based medicine (EBM) made it as savior but it was close. Championed by Sackett in the 1990s, 1 EBM has received both support and criticism from researchers, clinicians, and policy makers. In this paper, we consider some common arguments for and against EBM. WHAT EXACTLY IS EBM? “Evidence-based medicine” conveys the idea that up-to-date evidence can be used and applied consistently in clinical prac- tice, in combination with the clinician’s individual expertise and the patient’s own preferences and expectations, to achieve the best possible outcomes. Evidence is provided by original research and by systematic reviews that F nd, select, judge, and integrate the evidence on any topic. This provides the basis for treatment guidelines, which incorporate expert interpretation of available evidence, at the same time taking additional argu- ments into account, such as treatment availability, costs, and ethical aspects. Hence, we move from evidence to practice. DEBATE Experience- or Evidence-Based Medicine? Clinical proponents of EBM have emphasized the range of evi- dence that can be used in clinical decision-making. 2 , 3 But “evi- dence” can apply to any observation, so proponents could ar- gue that there is always evidence, even if it is clinical experience without research data. 4 The acronym may in reality mean “ex- perience-based medicine.” Much of the evidence in any clinical guideline is likely to come from expert opinion. Most guideline From the * Arthritis Research UK National Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom ; † Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland ; ‡ Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands . Acknowledgement date: July 19, 2010. Revision date: September 22, 2010. Acceptance date: October 1, 2010. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No bene f ts in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Maurits van Tulder, PhD, Department of Health Sciences, EMGO+ Institute for Health and Care Research VU University, De Boelelaan 1085, Room U454, 1081 HV Amsterdam; E-mail: maurits.van.tulder@vu.nl.
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This note was uploaded on 01/03/2012 for the course TECHNIQUE 61603 taught by Professor Bhogal during the Fall '09 term at Palmer Chiropractic.

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EBCP Editorial - SPINE Volume 36, Number 17, pp E1121E1125...

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