Thursday, 16 January 2014

Enough of "Real EBM" do we need "Real EBD"?

On Tuesday this week I was fortunate to be able to be in Oxford to listen to a number of "big" thinkers in the Evidence-Based Medicine (EBM) world discuss what "real EBM" is or should be compared to "rubbish EBM".

My sense was that there was a feeling that the EBM phrase had become muddied over time, perhaps as it has become used for political and persuasive methods rather than as a skill or tool to help us help our patients.

Below is a storify I created from the discussions on the Evidence Based Health JISC listserve (which I encourage anyone with an interest in evidence-based health to look at) before the meeting and from the tweets that went up during it.

But what was striking for me as a dentist is that this field is dominated by those with a medical background and, whilst many of the principles of EBM can be transferred to Evidence-Based Dentistry, I wonder if the way in which we encourage research use differs. For example, we work in very different payment systems from the Quality Outcomes Framework indebted system general medical practitioners work with. And we lack the large trials and guidelines that many parts of medicine are endowed with.

So do we want to begin updating our view of what real EBD is? But this time, can we do it bottom up so that EBD is meaningful for the primary care dentists who make up the majority of our profession?

My slight unease during the meeting on Tuesday was that I still feel the basic principle set out in the 1990s - that research is there to help the patient-doctor relationship come to better decisions for patients - is unchanged and that really what we should be discussing is how to keep the principles from being sullied, whilst learning to understand better in the dental clinical context, just how we can help the dentist-patient relationship use research where and when appropriate.

Anyway - here's what happened as recorded in Twitter and the Evidence Based Health Listserve...