evidence-based medicine


Health Economics

  • (written as Evidence-based Medicine)

    The practice of medicine informed by the best available evidence of effectiveness and other empirically amenable aspects of the clinical management of a patient. There is a lot of argument as to what constitutes evidence and the weight to put upon different kinds (for example, evidence from randomized controlled trials or from observational stud- ies). There is remarkably little evidence that evidence-based medicine (often abbreviated to EBM) leads to better health outcomes for patients, though it must be said that this is absence of (good) evidence rather than (good) evidence of absence of effect. Many people prefer the term 'evidence-informed' on the grounds that there is more to decision-making than mere evidence.

    Those who attempt conscientiously to use evidence in their deci sion-making commonly need to confront the following issues: the absence of scientific research (clinical, economic, social) on an important aspect of the matter to hand; a too narrow interpretation of 'scientific' (e.g. to exclude economic and social evidence of a statistical kind); the irrelevance in part or whole of such research as may exist; the need for interpretational skills that they do not have (especially with multidisciplinary material or evidence from disciplines not represented amongst the decision-making group); research of poor quality; research that is dated; research (even high-quality research) whose outcomes are ambiguous and conditional on unknown factors; research that is controversial and contested by expert researchers in the field; research of high quality when judged by a criterion such as internal validity but poor when judged by another such as external validity ; research that is of one level in respect of its clinical or epidemiological quality or completeness but of another in respect of its economic or social character; the need to supplement research evidence by the practical experience of clinicians and other professionals either to 'fill gaps' in knowledge or to form judgments about the quality and relevance of such research as exists; non-technical issues as to whether a technology is sufficiently effective to warrant recommendation/use; non-technical issues as to whether a technology's probable benefits justify the costs that can be attributed to its introduction and use and the associated risks attached to its use; how much uncertainty to accept and how best to hedge against risks; how best to explain to stakeholders how all such factors have been balanced.

  • acronymEBM