The need for evidence-based, non-drug medicine.
Evidence-based medicine (EBM) is defined as "the integration of best research evidence with clinical expertise and patient values." EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician's experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5-50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient's values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced.
Quailty of Life Research Center, Copenhagen, Denmark. ventegodt@livskvalitet.org
Søren
S
Ventegodt
Gary
G
Orr
Joav
J
Merrick
D035843:Biomedical Research / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D000529:Complementary Therapies / Q000941:ethics / Q000379:methods / Q000523:psychology; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine / Q000379:methods / Q000458:organization & administration; D006801:Humans; D010358:Patient Participation / Q000523:psychology; D057240:Patient Preference / Q000523:psychology; D061214:Patient Safety / Q000592:standards; D010817:Physician-Patient Relations / Q000941:ethics; D016896:Treatment Outcome