TY - JOUR
T1 - Is the evidence-based medicine movement counter-productive
T2 - are randomised controlled trials the best approach to establish evidence in complex healthcare situations?
AU - Jacups, Susan P.
AU - Bradley, Clare
PY - 2023/3
Y1 - 2023/3
N2 - In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with ‘objective’ evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants’ health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.
AB - In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with ‘objective’ evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants’ health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.
KW - Evidence-based medicine
KW - Academic research
KW - randomised controlled trials
UR - http://www.scopus.com/inward/record.url?scp=85150305646&partnerID=8YFLogxK
U2 - 10.17061/phrp3312303
DO - 10.17061/phrp3312303
M3 - Article
C2 - 36918391
AN - SCOPUS:85150305646
SN - 2204-2091
VL - 33
JO - Public Health Research and Practice
JF - Public Health Research and Practice
IS - 1
M1 - e3312303
ER -