I very much enjoyed both the humor and the not-so-hidden subtext of the letter on evidence-based medicine, submitted by my friend and colleague Dr Ian Mitchell [BCMJ 2009;51(10):426 [9]].
Along the same lines, would it be possible for one of our esteemed experts to ponder the following question: Is there evidence that evidence-based medicine is beneficial in the scenario of the individual patient, individual physician, office visit context?
We are all aware of patients who do seem to do well with a medication whose benefits have been nullified or disparaged by a team of worthy evaluators. Is this entirely placebo effect, or could it be due to difference within populations? Can large-population studies be extrapolated to the individual?
Of course, we must all be aware of such studies when we are making therapeutic decisions. But sometimes a hunch, based in part on intimate knowledge of the patient, turns out to be the solution to a puzzle. Surely this is one of the advantages to having a GP to call one’s own.
Unfortunately, the EBM proponents (all of us!) have the power to sway bureaucratic decisions. It isn’t right to deny a patient coverage of a medication just because the Therapeutics Initiative says a lesser product is just as good. I can personally attest that pantoprazole works better for me than does rabeprazole, and Therapeutic Initiatives cannot argue that point!
—Lorne Walton, MD
Maple Ridge
Links
[1] https://bcmj.org/cover/april-2010
[2] https://bcmj.org/author/lorne-walton-md
[3] https://bcmj.org/node/3710
[4] https://bcmj.org/print/letters/re-evidence-based-medicine
[5] https://bcmj.org/printmail/letters/re-evidence-based-medicine
[6] http://www.facebook.com/share.php?u=https://bcmj.org/print/letters/re-evidence-based-medicine
[7] https://twitter.com/intent/tweet?text=Re: Evidence-based medicine&url=https://bcmj.org/print/letters/re-evidence-based-medicine&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://bcmj.org/javascript%3A%3B
[9] https://bcmj.org/issues/re-roots-ebm
[10] https://bcmj.org/modal_forms/nojs/webform/176
[11] https://bcmj.org/%3Finline%3Dtrue%23citationpop