> The evidence-based medicine: EBM Evidence based medicine

La EBM – Evidence based medicine

The evidence-based medicine (EBM) is developed in opposition to traditional medicine, in part, based on impressions, intuitions, or on the so-called “clinical eye”.

This setting has essentially two meanings: the first takes into consideration the scientific proof that very often the reviews doctors have proved to be erroneous when è was possible to make precise measurements, the use of invasive techniques, or even the post-mortem examination.

it Is basically a clash between the tendency to believe that medicine is an art and thus cannot be subjected to the general evaluation and the attempt to introduce in the medicine major elements of certainty stemming from an approach più scientific in the establishment of usò that is good for the patient compared to the usò that è irrelevant or even harmful.

The EBM search the più possible through controlled clinical studies, repeated più times to be able to realize the meta-analyses, and observational studies in the condition of current medical practice, to determine what types of diagnosis, drug treatments or other rehabilitation.
have chanceà to be useful to the patient in term of risk / benefits ratio. it Is a continuous work, without stopping, because; the medicine progresses more and moreù quickly and thus requires a constant update on the part of all: physicians and researchers.

You should also add that the EBM is not; a culture’s descent from the top, né much less the gospel, but on the contrary, is a knowledge that must be made by the physician to be able to use it at the level of individual sick people who are never the same between them. The EBM is a way to be più critical; è also a methodology that should help the doctor to respond to questions that arise spontaneously.

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For example when any medical intervention is important to ask: “What are the scientific bases?”, “What benefits can I expect?”, “What are the risks?”?, “If we do not prescribe this treatment, the patient is avrà the disadvantages?”.

with such questions, the interventions become necessarily more rational, don’t chase trends, but to stimulate the critical spirit and the desire to be able to respond to questions in a way più precise.

The lack of data

The EBM also has powerful enemies. First of all, the lack of data; it is estimated that over 50% of the acts medical does not have a solid scientific basis; they can be useful or harmful, but we don’t know.

In this sense, the application of EBM is also a stimulus to increase research to fill in the gaps. The same doctor, together with other colleagues, può try to collect data, creating research projects that respond to questions maybe simple, but of great practical importance.

The influence of advertising;

The other enemy is the advertisingà that è a form of knowledge that is distorted in favour of the want to sell something. Advertising; or advertising – even if it is out of the fight for information – è particularly sustained in the field of pharmaceuticals, where manufacturers spend huge figures that exceed 20% of the turnover of the company.

This advertising will be supported by an army of more than 20.000 informants analogues work every day to an extraordinary pressure on the doctors to increase prescriptions with methods that in many cases, without wanting to generalize, they are at the limit of what is permissible.

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Unfortunately, it is difficult to avoid the advertising; also becauseè è the same pharmaceutical industry that funds the journals, conferences, meetings, certainly not with the aim to criticize its products or to stimulate a austerità requirements.

The same company; in science are often funded by industries that often leads to major conflicts of interest.

This excessive sponsorship of pharmaceuticals also raises the issue of how reliable much of the knowledge deemed indisputable.

The volume of Clinical Evidence wanted by the Department for the Evaluation of Medicinal products and Pharmacovigilance of the Ministry of Health and realized by the Centro Cochrane Italiano, and from the publisher Zadig on the texts of the British Medical Journal has the aim to fill the void.

Agosto 2008