Saturday, 25 February 2012

Evidence Based Medicine- An Inquiry into Effectiveness and Efficiency

Clinical practice seems a bombardment of conventional and unconventional approaches towards that of the maladies plaguing bodily form and function. The very culmination of the medical establishment as a therapeutic and social force. With an armamentarium of physicians on a single dimension of the sphere and the myriad of accessible literature on another, it stands as a provocative establishment of prestige and clinical intervention. Medicine, as a force conquering those physiological fronts is at the threshold of an unprecedented internal conflict. One that foresees the plaguing of its institutions with dogma. The suppression of those innovating and inquisitive clinicians driven to make a profound impression. The advent of evidence based medicine as a clinical and medical utilisation has provoked reaction from both ends of the establishment. An institution from which its modest beginnings one can draw an evident line of effectiveness and efficiency. A striving to draw the best clinical evidence via that of the scientific method. An uncompromising state of clinical and medical advance; marked by scientific basis to modern medical practice. A fabrication of the controlled clinical trial, the very gold-standard of clinical based knowledge and the prioritisation of the individual values and expectations. It is truly a miraculous evolutionary tale. How a concept doused liberally with altruism and cutting edge clinical execution. An expression of the underlying effectiveness and efficiency bound by a passion to restrict harm and reinforce that of the good. Undeniably, an entire host of those physicians and clinicians fail to conquer the essence of such an invaluable reality. Capitalising on the exclusive tenets of the evidence based medicine and posing obliviously to the observation and execution that it proposes. Evidence based medicine as an observation and as an execution is manifestly professed with the genesis of the randomised control trial. With the advent of maladies, disease and disorder that teased the likes of those leading physicians, where did the evidence lie as a basis for their practise? And did they reinforce harm and ignore pleas for that of the good? One of the most preeminent tales of the evidence based genesis arose with that of Professor Archie Cochrane. Pioneer of the controlled trial and Edison of the modern evidence based practice; his name remains synonymous with the scientific method in and around the establishment. While championing for evidence, Cochrane acknowledged the cruciality of the randomised control trial. Placing arbitrary individuals in a pair of arbitrary ‘controlled’ and ‘experimental’ categories, he rewrote the dogma and converged on a front no innovative physician had ventured. In more contemporary times, Cochrane’s paradigm stands as memorial as few regard its role and many regard is misinterpretation. For as long as we are instigating medical and clinical advance, we will be approached with scepticism and mistrust. We will be interrogated and asked of any ‘evidence to substantiate our toil’ and our ever move placed under the stethoscope. It is this mass misinterpretation of evidence based medicine that breeds the depletion of the values it originally aimed to substantiate. Depletion and a diminishing of the fabric of the establishment and those innovating physicians. "I knew that there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention”, proclaimed Cochrane as a frontier was incurring an impending, yet profound transfiguring….

No comments:

Post a Comment