Good question Evelyn & one I've been pondering. Ioannidis recently said EBM's been 'hijacked' by vested interests (not just industry). He's referring to the 'E' in EBM. I agree. As do my colleagues bmj.com/content/357/bm… /1
For me the very word 'evidence-based' has also been hijacked to the point where I consider it meaningles in/of itself. You ask 'How do you know?'. It's simpler than you think. EBM is a SKILL. /2
And there are sub-skills within it. The overarching skill (& the hardest to master IMO) is the ability to use your clinical expertise in helping patients understand and inform their decisions by evidence (defining this is key and requires SKILL). /3
Defining 'evidence' is another key skill that needs learning (you’d be surprised how many folk don’t have this skill. Heck, I'm still learning!). Everything from basic to applied science, from n=1 anecdotes/observations to n=millions = evidence. /4
The key thing is what these different forms of evidence can, & more appropriately cannot tell us. The types of questions they can & cannot provide answers to. How much certainty we can & cannot put on them (due to random and systematic bias) /5
Luckily there is a way to be able to ascertain which 'evidence' is more likely to provide the best answer(s). It's called, wait for it, CRITICAL APPRAISAL. Though I swap the word 'critical' for 'systematic' in my teaching /6
Coming back then to your question 'How do you know? [if someone is being 'evidence-based' you ask them this: "Please can you tell me how you have judged that the evidence adequately addresses the question/problem?" /7
If judgements don't go beyond 'others have said/shown/looked at etc.,' take it as a sign they probably don’t know/care what the evidence really says. Those that have this skill should happily share the method of how they arrive at their judgements /8
That's the simplicity. METHOD. There are methods to judge the quality of evidence. It's a skill that requires learning - one that more people don't have than do. Simply asking about methods will tell you just how 'evidenced-based' judgements are. /9
I also put less weight on 'standing' and status than I once did - it's suprising just how few folk have put the time/effort to obtaining/maintaining these skills, including many 'Top People'. /10
All this is why I pay close attention when I see the word 'evidence-based' - it has been hijacked. We need to weed out the 'pirates' - the way to do it is to ask how evidence was judged. I Hope this was helpful & thanks for raising this.
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