Abstract
to medical training, but also to clinical practice, research activity, health care management, pur chasing and policy making. The proponents of EBM point towards an ever larger gap between research findings and clinical practice, as doctors are increasingly unable to keep up with vast amounts of new information. New technology can be used to bridge that gap. Instead of advocating a form of treatment because of tradition, clinical intuition or deference to a senior colleague, a doctor may go to a computer and look up the available research evidence. The Idea is very attractive. Doctors are kept up-todate in their practice, they continuously educate themselves, and patients receive the best treat ments. Similarly managers, purchasers and health politicians can make informed decisions based on an increasingly sophisticated database. The development of guidelines and protocols, enforced via the lever of contracting, may be seen as bringing order into the chaos of widespread variations in clinical practice (McKee & Clarke,
Highlights
Working Group, 1992: Rosenberg & Donald, "1e9v9id5e).ncWe-beashedave evneorwythminogv"ed(Smonitht,o 1a9n95)erawitohf the term 'evidence-based' being attached to medical training, and to clinical practice, research activity, health care management, pur chasing and policy making
As a discipline with diverse psychosocial as well as biomédicalroots, psychiatry has perhaps been more hesitant than other branches of medicine in embracing the approach
While earlier reports gave an estimate of only 10-20% of medical interventions being based on scientific evidence, a recent study on general medical in-patients found that in 53% of patients the primary treatment was supported by rando mised controlled trials (RCTs; Ellis et al 1995)
Summary
The term 'evidence-based medicine' (EBM) was cstouidneendtsto tdheastcreimbephaaslieseasrnintghe s"tprartoecgeyss foorf smyesdteimcal atically finding, appraising and using con tcelminpicoarlaneoduecsisiorness"earch(Evfiidnednicneg-sBaassedthe Mbaesdisicinfoer. Working Group, 1992: Rosenberg & Donald, "1e9v9id5e).ncWe-beashedave evneorwythminogv"ed(Smonitht,o 1a9n95)erawitohf the term 'evidence-based' being attached to medical training, and to clinical practice, research activity, health care management, pur chasing and policy making. The proponents of EBM point towards an ever larger gap between research findings and clinical practice, as doctors are increasingly unable to keep up with vast amounts of new information. Much hostility was evident in a recent debate on the topic in the Lancet in which proponents of EBM hailed the approach as a paradigm revolutionising medical paurathctoircietariaannd, ca"roicliagtuarrcehdic tarandditioclnoasled"me(dMicairnsehalal.s 1995). They pointed towards many "inexcusable delays and inexplicable variations in the incor pporarcattiicoen" (oSfacekveitdt,enc1e995i)n.toBytrcaodnittiroansat,l crmiteicdsicaolf. EBM have pointed out that it is not a new idea and that good medicine has always attempted to iOntchoerrpsoratheavethecablleesdt atvhaeilabtelermsci"eanntificexaemvipdleenceo.f newspeak" that "would have delighted George Orwell" (Fowler, 1995) and have criticised its exponents for "their arrogance, their jargon, and their penchant for denigrating others . . . The steps and recommendations of the evidence bpalasteidtudmese"dicin(Me oragcaonly, tes19r9e5e)k. oTfhoebfutsocnaetionof atnhde debate clearly distracts from the underlying issues of the significance, benefits and limitations of EBM
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