Evidence-Based Medicine (EBM): The True Gold Standard?

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I recently decided to enroll myself into a health studies course at school which approaches the ideas of health, illness and well-being from different perspectives. The course has already allowed me to view the healthcare industry in a different light, especially coming from a rigid science background.

We recently had a discussion on Evidence-Based Medicine (EBM) and its validity of use within the healthcare field. For those unfamiliar with what ‘EBM’ is, it is an approach used in medicine whereby evidence is collected from large meta-analyses research and utilized in the creation of standard medical guidelines and protocols. EBM’s very own roots were established at my own university of McMaster. It is perceived to be  the gold standard in medical practice, and for good reasons too.  However, EBM’s critics also have points that all scientists should take into consideration.

Anyone who is trained to think in rigid scientific ways would definitely see nothing conceptually wrong with EBM. After all, its meticulous approach to research to find the best possible standard of care benefiting the majority of people is something needed in medical practices. Experts bring forth what EBM deems to be the best standard guideline or practice of treatment which helps reduce variability between the type of care delivered by health professionals, helps to lower costs and provides a scientific bases for important decisions (Timmermans and Mauck, 2005).

As science students, medical professionals, or vested stakeholders in the healthcare field, we’re not always aware of other perspectives. Science itself it seen to be the ‘end all be all’, but science is not the only form of valid knowledge (Hufford, 2003). As those in the realm of science, we are not trained to view things from a different angle. Should EBM really be the gold standard in the creation of guidelines and protocols?

Timmermans and Mauck argue that it is a form of ‘cookbook medicine’, one where practitioners blindly follow whatever is decided as the ‘best’. The counter argument towards the use of EBM is essentially: one size does not fit all. How can we say that a set of guidelines developed for one cancer patient can be applied in the same fashion for the next patient? EBM’s critics argue that it does not allow professionals to implement their experiences into their care and treatments. The authors also argue that the dependence on EBM can allow them to become ‘deskilled’ in certain situations wherein a case they face is not aligned with EBM-based guidelines (Timmermans and Mauck, 2005). Moreover, EBM’s rigidity often leads to lower guideline adherence rates by clinicians at all levels. There is no one perfect way to ensure each team member is doing exactly as the EBM outlines as necessary. It ‘s ‘power’ in the medical field can even be  used as a political tool in some cases by upper management in order to get clinicians to follow ‘the best practice’, even if it means cutting necessary costs, treatment interventions and even jobs.

What is advised by Timmermans and Mauck is to approach medical care from an angle that involves all stakeholders. Involving doctors, nurses, pharmacists, psychologists and cultural experts to recommend the best practices is the best method. There may not be something truly wrong at the core of EBM but clinicians should rather move away from their heavy dependence on it.

Biomedicine is a truly powerful field. Professionals often dictate what it is perceived by the majority of health professionals as what is best for us. As growing scientists and health professionals, we need to sometimes look beyond the surface at the deeper implications of the practices we implement. Science is a great lens to view the world, but it is only one of many lenses to view through.

Hufford, D. J. (2003). Evaluating complementary and alternative medicine: The limits of science and of scientists. The Journal of Law, Medicine & Ethics, 31(2), 198-212.

Timmermans, S., & Mauck, A. (2005). The promises and pitfalls of evidence-based medicine. Health Affairs, 24(1), 18-28.

Leena is a current undergraduate student in her final year of the Honours Life Sciences (BSc .) program at McMaster University. Her experience in taking a minor in Business has broadened her interests in the cross-sectional fields of science, business and health studies. When she is not busily writing, she assists students in branding themselves for success through the use of McMaster’s Learning Portfolio.




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