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Best Evidence: The best evidence rule
is a common law rule of evidence which can be traced back at least as far as
the 18th century. In Omychund v Barker (1745) 1 Atk, 21, 49; Cliché,
fashion, obsession, fad, trend, vogue, in thing, rage, frame, form, mold, mode,
taste, device
Is evidence based medicine a fad, a current trend, a passing
rage, or does it hold some breakthrough framework or mold that will results in
better patient care? The word evidence-based has indeed become a cliché. If one
were to view medical vogues as one would view a stock on the equities market,
one would look at the word with a high degree of suspicion. By the time a
company lands on the cover of Time Magazine, it’s stock loses its appeal, and
it is time to get out. Evidence-based, has become the watch word for every medical
or surgical endeavor. Medicine definitely embraces trends, which normally flourish
for a few years until someone else comes along and disproves the thesis. There
is nothing to disprove about evidence-based medicine; its name alone implies a
changing proof. The problem with keeping pace with medical science, however,
and distributing a convincing proof to the far flung reaches of clinical
medicine presents an impossible challenge, at least in the way we deliver medical
information today. The links below lead to a variety of evidence-based references
both for treatment and for diagnosis. The last one, notably a $66 paperback has
a publication date of 2009.
The problem is not the evidence; it is a problem of access, timeliness
and adequacy, not to mention relevance. Medicine is a fast evolving science. A
clinician, despite all claims to the contrary, is a scientist who must pyramid
clinical knowledge in order to access the Information needed for her individual
patient. Evidence-based medicine is a pyramid of carefully filtered information
which comes to a peak somewhere far away only to be published and discriminated
at a price in a branching fashion to the intended clinician. By the time the
information makes it to the clinician, it is no longer timely and it is based
on a question that most closely resembles the question the clinician is asking
for just one individual patient. Furthermore, the evidence is based on a statistical
population far removed geographically, and besides the patient is a statistic
of N1 who may fall anywhere in or outside of the evidence-based parameters. The
patient, furthermore, possesses a unique molecular-biological profile that is
most relevant to his or her condition. The accumulation of evidence-based
information has no way to relate to this patient as an individual. There is no
way that standardized care, guidelines or algorithms can keep pace with
bio-molecular medicine. The complexity is far too vast and the growth in
knowledge is far too fast.
So, let’s get beyond the fad of evidence-based and get on
with the problem of delivering current medical knowledge to the clinician
regarding the individual patient. The challenge is great. We must make that
information easily accessible, free and unlimited to the clinician. The patient
information too must be as complete as possible, and as inexpensive as
possible. There is no way to do this in an industrial free market framework.
Medical Information should replace best-evidence. The information should be
free to all physicians and their patients, emanate from the universities and
medical schools, and linked to the individual patient’s clinical and molecular
profile.
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