Caring with evidence based medicineBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3530 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3530
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Evidence based medicine definitely plays a prime role in health care delivery. But the question is to what extent?
According to WHO reports, around eighty percent of the world's population is still dependent upon a traditional system of medicine while most of the developing countries health care delivery system is also mainly based on the traditional system of medicine.
How to overcome this issue as health is the fundamental right of every human being in this world? There are many queries as this is a complicated issue. Like, if we just look towards the amount required to discover a drug molecule, it takes about seven years and costs roughly $282 million.
The other issues and solution for the same are…..
The traditional system of medicine certainly requires to generate a sufficient evidence base with the help of modern science as well as experimental rigor, in order for global acceptance.
As we know, evidence based medicine is mainly based on facts from cellular biology, molecular biology and its theories, whereas traditional systems of medicines use their own siddhant i.e. Principles to develop and monitor their medical theory. This is the right time to banish epistemological differences between contemporary and traditional systems by appropriate research methods, which help in the development of evidence base medicine.
In case of plant origin products we must work on analyzing the active ingredients from plants that possess medicinal properties and their role in disease management. Then we can move towards a scientific understanding of basic concepts like anatomical, physiological and pathological concepts outlined in plant based traditional medicines.
How to overcome these hurdles? This can be done by multifactorial efforts like interdisciplinary, inter professional, and inter professional educational approaches.
Evidence based medicine should produce studies which are significant to suitably positioned traditional medicines in the economically competent international market.
The general drug discovery process is based on ‘laboratory to clinics’ but in traditional medicine it is ‘clinics to laboratories’ i.e. what we call a ‘reverse pharmacology’ approach.
Quality, purity, safety and stability testing at the various stages of manufacturing formulations like raw drug collection to finished project phases is a crucial part of drug development.
The other issues to answer to make traditional medicine to contemporary ones are herb drug interaction, holistic approach, integrative, multidisciplinary etc.
Even Guyatt coined the term “evidence based” twenty five years back but still we are lagging behind in delivering evidence based health care delivery to all, even it is time consuming and requires huge funding. But we can solve the problem to some extent by thinking about supplying adequate pure drinking water and sanitation to the whole world, which protect people from many diseases.
Competing interests: No competing interests
Re: Caring with evidence based medicine: the example of bronchiolitis
Isn't this week’s practice update on bronchiolitis (1) an example of evidence-based medicine which “injects certainty” rather than doing justice to all the uncertainties that exist (2) - for clinicians and also for parents? I agree strongly that children with viral infections do not benefit from, and may even be harmed by, antibiotics; and that a very large number of children with bronchiolitis do not need hospital admission.
But simply 'reminding' doctors of the guidelines doesn’t really help the individual doctor faced with a child struggling to breathe. Many anxious parents will not be reassured, either, if they are simply told that the condition is self limiting and their child’s “breathing and feeding will get better within five days” (3).
Improved evidence around admission avoidance does indeed need “to be done” [sic] (1), but surely if we were going to follow the more practical approaches suggested elsewhere in this week’s journal (4), it might be more useful to work on some more specific and practical ways forward?
Why aren't there more evidence-based parent-friendly resources like whenshouldiworry.com? The trials of this showed a two-thirds reduction in antibiotic prescribing (5) and, in my experience as well as the trials, many parents really like it.
Are there any near-patient diagnostic tests that might help - like CRP, as used in a recent NHS Innovation award-winning project to reduce antibiotic prescribing in adults with a cough? (6)
It’s good news that reminding higher antibiotic prescribers of their outlier status, leads to reductions in antibiotic use (7).
But surely, with antimicrobial resistance flagged up as a potentially devastating global threat(8), we need to do more than finger-wagging at doctors. And developing more practical supports surely applies more widely than just bronchiolitis?
(1): p.29 in the hard copy 2 July edition - I cant find this electronically
(2): Caring with evidence based medicine BMJ 2016;353:i3530
(3): Bronchiolitis in children: NICE pathway: https://pathways.nice.org.uk/pathways/bronchiolitis-in-children
(4): Clinical encounters in the post-guidelines era BMJ 2016;353:i3200
(5): Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial BMJ 2009;339:b2885
(6): Challenge Prize cash supporting GP surgery to fight antibiotic resistance. https://www.england.nhs.uk/2016/05/antibiotic-resistance-2/
(7): Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Hallsworth M et al. Lancet 2016: 387; 10029: 1743–1752
(8): Tackling drug resistant infections globally. May 2016. amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf
Competing interests: No competing interests