Evidence Based Medicine - Is It Really Evidence
Evidence Based Medicine - Is It Really Evidence
Evidence Based Medicine - Is It Really Evidence
really evidence ?
1.Sound scientific basis which he had acquired from school and college.
Selection for M.B.B.S is based purely on proficiency in science subjects. It is to make sure that only students with
good scientific background are allowed to study medicine. It is the scientific base that makes a doctor in modern
medicine different from others.
2.Experience he gained over the years. You can call it practice based.
The experience shared by fellow medical practitioners also may be included in this.
3.Continuing education. Any doctor practicing medicine must keep him updated with the latest
development in medical science and technology. This is possible by going through newer editions of text books,
reading journals, attending CMEs, conferences and by hearing medical representatives. Both journals and
medical representatives most of the time highlights statistical data and this is known as evidence based medicine.
Now let us compare and contrast these 3 aspects of medical practice
Scientific based medicine v/s evidence based medicine
• Science says steroid knocks out the body’s ability to fight and get
repaired.
• But, we were forced to use it for spinal cord injuries, for about a
decade because of evidence
This is what happened
Pfizer company did these studies called NASCIS and the person who did these studies is
Dr Michael Bracken. He is not a medical doctor, he is a Statistician. He used evidence
based medicine statistics to prove that Solu medrol helps recovery of paraplegics. Later
it was found that he manipulated the numbers and figures and faked the whole study.
The new analysis of his numbers showed not only that Solu medrol does not work, But
also that it increases mortality rate.
1999 to 2004 Campbell has recommended Solu medrol and we were forced to use it.
But why 2020 Campbell does not tell that this study was fake and fraud?
In this article published in Journal of Orthopedic Association of South Indian States (JOASIS), I have
revealed how industry manipulated data, for their advantage. For lack of time I am not going to the
details. But I humbly request all to conveniently go though this article, published last year, available
online.
Practice based medicine v/s evidence base
Watson Jones in his classical text book Bone and Joint injuries, contempt operative treatment of
fracture clavicle by saying
‘Nonunion clavicle is rare except when some foolish surgeon do primary operative reduction’
Any orthopedic surgeon with experience of more than 30yrs of practice might have treated at least
1000 cases of clavicle fracture and all of them till recently were treated by fig of 8 bandage or
clavicle brace. Nobody might have thought of any other treatment.
Last 2 decade witnessed AO coming out with specially designed plate for clavicle. Then evidences
started pouring in favour of internal fixation of clavicle.
Internal fixation may be superior. But evidences are appearing so strong; you may be sued for
treating fracture clavicle by brace.
Court (judiciary) look for evidences only.
• They haven’t studied medicine so lacks any scientific basis
• They have haven’t treated any patient so cannot understand practice based
medicine
• As we doctors comes under consumer protection and court is the final authority
in judging our treatment, we are doomed to follow evidence based medicine
A situation is emerging in which you are forced to do your practice, based on
evidence based medicine only and compelled to neglect scientific and practice
based medicine.
All the efforts that were taken to cultivate a scientific mind, during school days and
depth of knowledge acquired in medical sciences, become futile.
All the experience we painfully gained during our practice is also of no use.
This is a situation any doctor with self esteem will find difficult to
digest.
Dear Doctor
Next time when you are introduced to a new product whether it is a drug or
equipment, analyze with your scientific mind and take a decision.