Evidence-based medicine (EBM) represents a pragmatic shift in healthcare, influencing the way care is administered, delivered, and evaluated. As an approach to care, EBM promotes the systemic evaluation and adoption of the latest relevant research for patient care. From the hallowed halls of research labs to frontline exam rooms, EBM aims to make medicine less dogmatic, and more data oriented. However, as EBM establishes itself as the new paradigm, questions persist about whether its focus on data makes it more scientific and if its applications are improving patient care in the ways EBM’s proponents aim to.
Those questions beg a distinction between EBM and the less familiar but just as important science-based medicine (SBM). While the two terms may seem similar, they represent two different philosophies:
Evidence-based medicine: The practice of EBM involves the application of relevant and systematically evaluated research to the specifics of each patient, the health population they inhabit, and the characteristics of their medical case. The emergence of EBM was a response to the previous era’s “eminence-medicine,” which some believed had become too dogmatic to appropriately incorporate new data. It also aims to counter clinicians willing to apply treatments strictly on the biases of their clinical experience.
Science-based medicine: SBM applies scientific rigor and systematic empirical consensus to create a framework for evaluating the value of less established treatment protocols. “Less established” could be treatment modalities outside of conventional medicine or include more holistic evaluation and treatment of patients.
How EBM Promotes Patient-Centered Care
EBM brought together two aspects of care that may have once been seen as at odds with one another: individualized care and evidence from medical research. EBM supporters have argued that the previous era of relying on medical tradition and the gold standard of treatment efficacy diminished practitioner agency and left patients feeling unheard. By combining a variety of evidentiary sources when making patient treatment decisions, and developing empirically-based care options, EBM is flexible in how it works to influence care.
And while EBM has affected care where it matters most—between the patient and their physician—it does not, on its own, act as a fool-proof mode of analysis when considering the soundness of a clinical approach. EBM has no doubt broadened the physician toolkit to include a means of addressing the unique needs of patients.
The Impact of EBM on Practitioners
The impact of EBM is being felt throughout the healthcare industry. It is being adapted to other medical trends such as personalization and integrated care. In its earlier days, EBM was seen as a counter to traditional medical perspectives that did not always update with new evidence and could overly rely on medical dogma or a clinician’s gut instinct. EBM puts more weight on the judicious evaluation of single or small collections of studies that would have previously been ignored for straying too far from established practice.
Over time, EBM has evolved to incorporate a wide range of sources, including patient interviews, point-of-care testing and software applications, anecdotes, and individual research studies.
That expansion includes newer approaches such as empowering physicians instead of relying on healthcare conventions, practically assessing research evidence, and meeting patients ‘where they are’ (patient values) when considering optimal treatments. Newer conceptualizations of EBM emphasize cultural competency and research from specific populations as a means of balancing the focus on individual patients and applying proven clinical interventions.
As a perspective that first emerged in the 1960s, EBM isn’t going anywhere anytime soon. Many clinicians feel that’s a good thing. However, its widespread adoption and acceptance by medical authorities aren’t without scrutiny.
Science-Based Medicine vs Evidence-Based Medicine
Independent experts and observers believe that by changing their medical perspective, physicians are increasingly abandoning still-relevant scientific principles. There is also a case to be made that these two perspectives support one another, bringing out the best in each.
But the independent clinical judgment that empowers physicians to provide a wider range (and sometimes more holistic) set of clinical interventions sometimes fails to meet basic scientific rigor. A growing chorus of researchers and leading clinicians are concerned that to meet patient needs and demonstrate a willingness to diversify practitioners’ approach to care, it is possible to minimize the basic scientific principles that drive the field of medicine.
At its core, SBM provides a clear basis for EBM critique: A bias towards recent evidence that can be unmoored from basic scientific principles. These could be considered contrary to the principles that have driven medicine for generations including testability, refutability, clear and justifiable metrics of success, and peer review. Critics of EBM have alleged that a willingness to accept new evidence as medical fact has fostered an environment for health quacks and well-meaning practitioners able to find evidence confirming their worldviews almost anywhere.
How SBM Can Support EBM
While feedback is mixed as to what extent properly applied EBM supports individual clinical judgment and personalized care, concerns are that practitioners are using EBM as a reason to expand what constitutes scientifically-valid evidence. While the so-called medical dogma of the past was ripe for replacement by the more proactive philosophies of EBM, some of what made it a more cautious approach remains valid. Overall, practitioners should not abandon the lessons learned in medical school. Outsized claims and protocols far outside the accepted norm could be too good to be true. Additionally, even if treatments show promising signs early, replicability remains important, especially when replacing more established treatments.