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
-
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.
-
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.
-
Ma J, Stafford RS.
Quality of US outpatient care. Arch Intern Med.
2005;165:1354-1361.
-
Ioannidis JPA.
Contradicted and initially stronger effects in
highly cited clinical research. JAMA.
2005;294:218-228
