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A critique: The good and bad of a review
Debbie McMullen,Rhett McClean,Sok Cheon Pak 셀메드 세포교정의약학회 2015 TANG Vol.5 No.3
Evidence based medicine involves using both the individual clinician’s expertise and the current best available external clinical evidence from systematic research in deciding on the appropriate care for individual patients. The current approach to evidence based practice in healthcare adds a third component which is patient values. Evidence based practice is thus a triad, in which the practitioner’s expertise, research evidence and the patient’s values are all given consideration. The balance to be struck between them depends on the individual case. The literature indicates that complementary medicine practitioners are moving away from traditional knowledge and towards the use of evidence based practice in their clinical discussions. In the context of the daily practice of complementary medicine practitioners and their continuing development of their knowledge base of evidence based practice, this short review discusses the good and bad of a review journal article.
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Evidence based practice within the complementary medicine context
Lisa McLean,Peter Steve Micalos,Rhett McClean,Sok Cheon Pak 셀메드 세포교정의약학회 2016 셀메드 (CellMed) Vol.6 No.3
Evidence based practice (EBP) is a system of applying the most current and valid high quality evidence to support clinical decision making in a healthcare setting. In the twenty five years since its inception, EBP has become the accepted benchmark for excellence in healthcare. Although the system emerged within the biomedical sciences, in the years since EBP has become normative across all healthcare modalities from dentistry, allied health to complementary and alternative medicine (CAM). Practicing evidence based medicine within any modality potentially offers the patient the best available care based on high quality evidence. Yet it is the nature of the evidence that provokes some questions about the suitability of EBP across all modalities of healthcare. The meta analysis of randomized controlled trial (RCT) stands at the pinnacle of the hierarchy of evidence in EBP. This forms a challenge to CAM due to the difficulty in reducing the elementals of a holistic naturopathic assessment of a patient into an answerable question to be tested within a RCT. On one level this makes EBP paradigmatically incompatible with CAM, yet on another level it presents the opportunity to redefine the parameters of what is considered high level evidence. EBP has become a tool, and at times a weapon wielded by governments and health insurance companies to direct healthcare funding and policy. The implications of the nature of accepted evidence are becoming far reaching. The pursuit of the best available healthcare for each individual is the focus of EBP. However, the injudicious use of this system to direct health policy is fraught with biomedical bias and dominance. This issue raises the challenge to CAM to present high level evidence according to the rules of evidence, or face the annihilation of centuries of empirical knowledge.
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