Evidence-based medicine: an overviewThe 4 movements of modern

medicine

1. Between 1950s and 1960s

1. A British epidemiologist (Dr. Archie Cochrane) noticed that most gynecologists were not aware of the results of RCTs, and have not implicated the findings into clinical practice.

2. He called for collecting, reviewing, and summarizing the results of RCTs.

3. His efforts led to the foundation of Cochrane collaboration.

Website: www.cochrance.org

2. 1970s-1980s

• advancements in the science of clinical epidemiology,

particularly in biostatistics with an emphasis on RCTs.

This led to the development of a peer-review

literature, evidence-based approach to medical

education and learning in the 1970s and 1980s

3. BIRTH OF EBM

• The term of “Evidence-based medicine (EBM)” was coined at McMasters University in

Canada in 1991 and appeared in print for the first time in 1992.

• Def.: It refers to a philosophical approach towards clinical decision making (EBM) and

establishment of healthcare policy (evidence-based healthcare, EBC) that emphasizes original

clinical research (mainly RCTs) in the peer-review literature as the source of ‘evidence’.

4. Today EBM

• The rapid spread of the concept of EBM became possible thanks to

1. progress in information technology,

2. electronic literature archiving and indexing,

3. the development of the Internet

Hierarchy (Levels) of evidence based medicine

Why to get engaged in EBM? An answer by giving example-The dramatic example of “flecainide”. - The story: When people had heart attack, developed arrhythmia and died from the arrhythmia. So, an anti-arrhythmic drug would save lives. - A paper was published in the New England Journal of Medicine introducing a new drug called flecainide.

The tragedy• The drug was then APPROVED by FDA, immediately after the 1st trial!!• Then, studies reported poor survival of people giving flecainide than

placebo!• So, despite a perfectly good mechanism for the usefulness of flecainide

(it reduces arrhythmias), the drug was clearly toxic and, overall, did much more harm than good.

• Unfortunately, thousand of people died by the use of this drug!

Lesson from the flecainide tragedy:• In other words, “up-to-date”, good-quality research findings need to be available to all medical practitioners on a routine basis.

• But, it is not that easy!!

We need evidence, but we have little time!• Doctors are always overwhelmed in their work. • Meanwhile, the number of research studies is rapidly increasing!

So, we need review•But, then come the topic, how to review the literature?

- We are going to learn about: - Narrative review vs. systematic review!

See, the next video