Evidence-based medicine (EbM, v. English evidence "proof, proof, reference ") refers to information from clinical studies, which confirm or disprove circumstances.

The German translation of the term evidence based medicine is misleading (case of translation). Proof-based medicine would be correct.

A related term is the evidence-based health care ("Evidence Based Health Care "), with which the principles of the EbM are used on all ranges of the health care, including decisions for the controlling of the health system.

Definition

EbM "is the conscientious, express and reasonable use of at present best external, scientific evidence for decisions in the medical supply of individual patients. The practice of the EbM means the integration of individual clinical expert's assessment with the optimum external evidence from systematic research. "(Quotation: David L. Sackett et al. Which evidence-based medicine is and which )

The term "evidence based medicine "was coined/shaped 1993 by Gordon Guyatt from the group around David Sackett to the McMaster University, Hamilton, Canada. By evidence-based medicine (EbM) or evidence-based practice strictly speaking one understands a proceeding of medical acting to supply individual patients on the basis of the best data the available. This technology covers the systematic search for the relevant evidence in the medical literature for a concrete clinical problem, the critical evaluation of the validity of the evidence for clinical-epidemiological criteria; the evaluation of the size of the observed effect as well as the application of this evidence on the concrete patients with the help of the clinical experience and the conceptions of the patients.

The EbM is been based a paradigm change in the medicine and on the application of scientific methods, which cover the whole spectrum of medical activity and critical parameter also long established medical traditions, which were not systematically analyzed ever.

History

The idea of the evidence-based medicine leaves itself on in the 2. Half in 18. Century of British physicians developed concept "medical arithmetic" leads back (William Black: Arithmetic and Medical analysis OF the Diseases and Mortality OF the human Species, London 1789). The designation in that is to 1793 published articles "on attempt ton improve the Evidence OF Medicine" of the Scottish physician George Fordyce first (And quotes: Ton of Improve the Evidence OF Medicine. The 18th Century British Origins OF A Critical Approach. Edinburgh, Royal college OF Physicians OF Edinburgh).

In Great Britain also one of the first controlled clinical studies was accomplished. Already 1753 published James Lind the results of its attempt to treat scurvy with oranges and lemons.

In the German-language range comes, the Hungarian physician active in Vienna Ignaz roll-point (1818-1865) the Erstautorenschaft for the introduction of the "systematic clinical observation" into the medical research too (1848).

1972 the published book "Effectiveness and Efficiency: Random Reflections on Health services" of professor Archie Cochrane, a British epidemiologist, marks the beginning of the current international efforts over "Evidence based Medicine". Its further work led to an increasing acceptance of clinical epidemiology and controlled studies. Cochrane was appreciated by the fact that an international network for effectiveness evaluation in the medicine - which was designated Cochrane Collaboration - after him.

Cochrane LIBRARY

The LIBRARY of the Cochrane Collaboration (the Cochrane LIBRARY in such a way specified) meets systematic overview work in English since 1992 and on nearly two thousand work increased. Beyond that it contains a register with quotations of clinical studies (approx. 400,000 entries), which goes beyond the existence of conventional data bases (Medline, EMBASE). By its electronic spreading (quarterly updates in the Internet and on CD-ROM with a comprehensive search function) it made the EbM a generally recognized basis of everyday medical work.

In the recent time is tried to make the LIBRARY multilingual as articles on Italian, Spanish and Chinese automatically or by hand are regularly translated and made available on the other hand also in these languages all anderssprachigen articles (in particular English). The Cochrane Collaboration regards the inclusion of the patient opinion into the health care as fundamental. Therefore there is an layman-understandable short summary to each systematic overview work (summary).

EbM within the German-language range

The spreading of the EbM was carried in the German-language range considerably by the Institutionalierung of the German network for evidence-based medicine (DNEBM). Goals of the non-profit association with more than 600 members from all ranges of the population (February 2005) are

• Development of an open information and communication platform
• Development and switching of out, far and curricula of advanced training and - models
• Tuning of current EBM referred research, training and practice
• Execution of evaluation and research projects
• Advancement of theory, methods and ethics of the EBM.

In the German network for evidence-based medicine Evidence based only-sing represented (smooth) since 2002 by the specialist area care and health promotion are.

The use of the evidence-based medicine

The entire medical knowledge doubles itself at present every five years, whereby individual fields of activity exhibit very much stronger dynamics. With the abundance and developing knowledge is increasingly overtaxed the individual physician to determine the meaning for it. EbM sits down the goal of evaluating and of improving concomitantly the quality of the published medical data. Thus EbM serves the patient, the individual physician, the individual research establishment and the public health policy. However the EbM is still another recent science, which continues to develop likewise.

Gerd Gigerenzer endorses a reorientation of local traditions of the patient treatment to the secured statistic facts of the EBM. Designating for it the concept formation is, decisions informed there still rather an ideal as the reality already represents: one can imagine hardly scientists, who must make for instance advertisement for evidence-based physics.

The controversy between traditional and evidence-based medicine resembles the conflict between corpus linguistics and traditional linguistics. Computer-assisted methods made the empirical proof of realizations before rather faith-based easier also there.

Criticism at the evidence-based medicine

The substantial arguments of the critics are the following:

1. Physicians behaved "anyway always" as demanded.
2. A good proof is not feasible or too pedantic in many fields of the medicine. Nearly all medical actions, which are completely indisputable, are not evidence-based and it will never be.
3. Is not missing from proven using and absence of use is the same. Thus for example envelopes with "acetic acid alumina" help as house means against fever, although this still were subjected to no double-blind attempt.
4. The more data in large studies to be together pulled, all the more with difficulty it, with the patient, will compare the average patient of the study who - in here and now - sits before its physician.
5. Causalities can remain unsettled for a long time. Statistically one can speak often only of correlations, sometimes of secured connections. Sometimes from others than static connections (for instance cell attempts, bioassays) one can judge a safe causality (for example with many infections).
6. Fallacies are continued to discuss with the terminator points (Surrogat markers) by medical studies.
7. EBM is criticized by some (medicine) statisticians with the following argumentation: So studies with a large number are not so easily applicable to a special individual case. Large numbers supply statistically seen an exact result, from which one does not know, to whom it apply. Small numbers supply statistically seen an useless result, from which one knows however better, to whom it apply. To decide with difficulty, which of these kinds of Unwissen is the more useless. (Beck Bornholdt, Dubben 2003).
8. EBM is strongly advanced from career and financial reasons.
9. The reality of the EBM emerges alone based on statistics. Experience medicine, social effects, individual decisions and emotions are not recognized.
10. The demand the value of a medical treatment for the individual concerning to judge, leads medicine" to the term "VALUE based. This value in the context to individual humans regarded - biopsychosocial model - is called "human based medicine". EBM can be a first step on the way to the HBM at best.

For all existing problems the evidence-based medicine proved itself successful in the following point as: Expressions medically "experts "became more than so far analyzable (medicine eminenzbasierte). A minimum of examinable vouchers is not sufficient to impress increasingly sceptical colleague shank. Statements must be replaced by arguments, which the relevant medical literature must support. Medical knowledge became analyzable more than so far.

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