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President's Column 7/17/05
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EVIDENCE-BASED MEDICINE:
ARE WE THERE YET?
Neal Kohatsu, MD, MPH, FACPM
July 17, 2005

Evidence-based medicine (EBM) has grown rapidly over the last 15 years. During this period, the specialty of preventive medicine seems to have embraced EBM. Has the rest of medicine? Has the public? A recent survey of primary care physicians suggests that many doctors are not adherents of EBM.1 Furthermore, the general public does not seem to be clamoring for more EBM, either.2

Prochazka and colleagues surveyed internists, family physicians, and obstetrician/gynecologists in three geographic areas across the country. About two-thirds of the respondents believed that an annual physical examination was important. Many also supported regularly obtaining lab tests of dubious preventive value (e.g., complete blood cell counts).1 Interestingly, a survey of the public conducted by the same investigators found that about two-thirds of the public also expected an annual physical examination as part of their medical care.2 The widespread use by the general public of unproven dietary supplements and other untested interventions also suggests that EBM is underappreciated.

Also just reported, Ma et al. looked at 23 quality indicators, derived from EBM, in a national dataset assessing outpatient care. They found many quality gaps, several in the prevention domain, and called for greater adherence to EBM.3

To make matters worse, in last week’s issue of JAMA, epidemiologist John Ioannidis noted that the results of one-third of highly cited clinical studies were not replicated by subsequent studies—either contradicted or found to have an exaggerated effect compared to follow-up research.4 Thus, Dr. Ioannidis reminds us that the evidence base is constantly changing and can be difficult to continually track even in a narrow area of practice.

Does this mean we should abandon EBM? No. These papers reinforce the notion that ACPM must continue to play a leadership role in supporting prevention research and the formation of policy and practice of medicine based on such research. These articles also support our strategic partnerships with organizations such as the American College of Medical Quality and the need to link with other like-minded professional groups who view the consistent use of a robust, science base as critical to improving health.

Just like the thousands of minivan drivers this summer who are en route to Disneyland, we have to say with respect to EBM, "We’re not there yet.” With perseverance, though, we will get there.


References

  1. Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ. Support of evidence-based guidelines for the annual physical examination. Arch Intern Med. 2005;165:1347-1352.

  2. Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ. Public expectations and attitudes for annual physical examinatons and testing. Ann Intern Med. 2002;136:652-659.

  3. Ma J, Stafford RS. Quality of US outpatient care. Arch Intern Med. 2005;165:1354-1361.

  4. Ioannidis JPA. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218-228

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