Do you use evidence based medicine on a regular basis in your practice?
What are its limitations, and how do they affect you?
In Part 1 of this 3 article series, you’ll discover what the limitations of evidence based medicine are and why.
Evidence Alone Is Not the Answer
Healthcare has always relied on evidence as the foundation to procedures. The quality and state of evidence has evolved over time to replace outdated or unproven procedures as we discover more about the human body. We cannot achieve perfection with evidence alone for the following reasons:
- Evidence is context sensitive. It is only a slice of a massive set of systems called life.
- Evidence is subject to variables both inherent within the study(s), and from outside forces.
- All variables are impossible to control and they range from bias, data manipulation, financing sources and the need to achieve success in the study, to unknown and yet undiscovered processes affecting the studies outcomes.
Evidence Based Medicine’s Impracticality
Evidence based medicine (EBM) started in 1992 in an attempt to segregate traditional, conventional and accepted norms in medical procedures from those procedures that were ineffective. EBM is often loosely and feverously used in a righteous sense by some proponents; however, clinical application of the concept at the exclusion of all other data is impractical for many reasons. The simplest being that any physician or therapist who accepts third party reimbursement (insurance) will only use the evidence based procedures he or she will be reimbursed for. Procedural exclusion forms a bias.
In the health insurance reimbursement model, these decisions are often controlled by profit and loss factors governing patient procedures and by other entities controlling or manipulating those same companies, i.e. government, pharmaceuticals and health care products and device manufacturers. Unfortunately, this is clear evidence of third party bias controlling an evidence based practice (EBP).
Join me next time to explore the limitations of evidence based medicine in two real-world examples.
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About the Author
Dr. Frank Jarrell is the leading expert on spondylogenic reflex syndromes and is the founder and developer of Spondylogenic Reflex Analysis (also known as Spinal Reflex Analysis) and Spinal Reflex Therapy. Learn more about Dr. Jarrell.