What you should know about Evidence Based Medicine

What is Evidence Based Medicine?

Evidence Based Medicine ("EBM") is a new approach to provide "written evidence", available through medical literature, about the treatment of animals. We practice EBM by systematically searching the medical literature for applicable studies, critically evaluating them, and determining the applicability of evidence. This is done so we can give animals effective care.

We want to always inform clients IN WRITING of the benefit, risk and cost of care we give. With a computer, access to Internet, and veterinarian newsgroups, it is now possible to find some type of evidence related to the benefit, risk and cost of every diagnosis, treatment and pet product sold. When we find this information, we distribute it to our clients, so they can also understand the benefits and risks of a selected product or treatment.

How is EBM Accomplished?

To accomplish this goal, we use a variety of veterinarian only Internet news groups. These news groups have a world wide subscriber base of over ten thousand veterinarians. Veterinarians all over the world with different backgrounds present their ideas and viewpoints. Veterinarians calling themselves chiropractors, herbalist, homeopaths, alternative medicine practitioners, acupuncturist, and family practitioners are there, as well as those with specialty degrees who have passed the educational requirements and tests recognized by professional organizations.

If clients have a clinically relevant question they want answered we can prepare what we call a VETCAT. These letters stand for Veterinary Critical Appraised Topic. In the human evidence based practice they are called just CATs. To make a VETCAT we take clinically important questions and search the veterinary and other Internet medical sources such as MEDLINE. Then we report the evidence to support our answer, usually providing clients with what is called an abstract and a listing of the reference sources of full articles. Clients can then order the full report at their request.

While the perfect study may not yet have been published, written up or even commenced, we always look for current information, articles, and evidence. Of course, we may have to settle for a study that is less rigorous, but we will then be on the look out for new research that supersedes older studies. If we find that there is no evidence that a treatment is effective, but find evidence the treatment is economically conceived just to make money, we are committed to informing the medical community and the public. However, we always let people judge for themselves.

Vaccine Labeling

Unlike human medicine, government label directions for biological treatments such as pet vaccinations do not need to be capable of producing a desired effect. The vaccine labels direction can be, and often are, contraindicated. Yet, the vaccination is still used and sold as directed. This only benefits the manufactures of the vaccines and veterinarians who want to use and sell treatments without providing the public with "written evidence" treatments are effective.

Proven vs. Unproven Treatment

Medicine treatment can be proven or unproven. Unproven treatment relies on relative efficacy and safety that has not been shown in controlled peer-reviewed clinical trials.

If a proven treatment is not available (which is often the case in veterinary medicine), or if the treatment not work for the individual patient (also more common then we would like), then there is nothing wrong with trying an unproven therapy. So long as the client is well informed an unproven treatment may be advisable.

However, the problem lies when unproven treatment is offered claiming that the treatment is effective, when in reality nobody knows. In some circles this is called medical fraud.

The new evidence based medicine paradigm puts a much lower value on authority. The underlying belief is that a family veterinarian or family physician can gain the skills to make independent assessments of evidence and evaluate the credibility of opinions being offered by experts. The decreased emphasis on authority does not imply a rejection of what one can learn from colleagues and teachers whose years of experience have provided them with insight into methods of history-taking, physical examination, and diagnostic strategies which can never be gained from formal scientific investigation. The practice of EBM simply relies on documented facts.

The goal of EBM is provide superior patient care through an understanding of the underlying evidence. With an understanding of the evidence, doctors can share information about the benefits, risks, and costs of a selected course of treatment to their clients.

By: Dr. Arthur Malernee