A proposal for ME Action: a commitment to evidence-based medicine

Thanks. I think it's a noble sentiment, and I can't see anything wrong with the text of your letter. However, I'm cautious about holding up so called 'evidence based medicine' as beyond reproach. EBM, and what is judged to qualify as EBM, is what's been used by policy makers to oppress us over the last 30 or 40 years. That last sentence is probably straying into hyperbole, but I think expresses what may be a concern for some people. Who says what is and isn't EBM? Depending on how advanced the field is and where investment has been made the weight of evidence my be skewed against the interests of patients.

But, of course all medicine should be based on the best available evidence.

For a critique of EBM read this piece by Bruce Charlton.
Zombie science of evidence-based medicine
 
hinterland said:
For a critique of EBM read this piece by Bruce Charlton.
Zombie science of evidence-based medicine
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I've just read it. It's a long rant that has a few ideas lost among the ranting. I think his main argument is that 'clinical epidemiology' which seems to mean doctors doing what they have observed to work, being replaced with clinical trials and meta analyses and NICE guidelines. He describes this as a cook book approach and thinks it's a bad thing.
 
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Aren’t we just saying we want to be clear that the statement definitely does not mean that we think the organisation should support the current flavour of the month known as Evidence Based Medicine or EBM. We simply think it should support basing medical practice on sound evidence. Can’t that be put in a covering email?
 
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NelliePledge said:
Aren’t we just saying we want to be clear that the statement definitely does not mean that we the organisation should support the current flavour of the month known as Evidence Based Medicine or EBM.
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I'm still not clear what the problem is with EBM. Surely it's better for doctors to base their practice on scientific evidence, including that from double blind controlled trials, rather than on what they've always done or what they were taught at medical school, or what they've tried out on a few patients and seemed to work.

How else do we replace 'stomach ulcers are a sign of stress, treat with therapy' with 'ulcers are caused by H pylori infection, treat with antibiotics'.

Edit: Apologies, I misunderstood. Should have read the following sentence more carefully.
 
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I wonder if the fact that ME Action is a US organisation (with international outposts) means that EBM is missing is more of an issue in the UK with the BPS brigade than it is in the US? Not a reason to ignore it, just perhaps an explanation why it got missed.

My pet peeve is that virtually all clinical trials in ME are very small and don't tell us any more than it is worth doing a bigger trial, and yet this is always reported by the media as amazing news and then taken up by the community, not surprisingly, as proving facts. I don't mean to underrate the progress and value from small trials as indicative, but that the reporting in the media is an issue.
 
Griffin said:
I wonder if the fact that ME Action is a US organisation (with international outposts) means that EBM is missing is more of an issue in the UK with the BPS brigade than it is in the US? Not a reason to ignore it, just perhaps an explanation why it got missed.
Click to expand...

I think it may be the way around. All advocacy groups are pretty much agreed that treatments like CBT and GET are not based on good evidence. The need to emphasise evidence quality is because ‘biomedical’ (drugs or surgery) treatments based on just as weak evidence are not similarly being called out. If anything that would seem to be a bigger problem in the US.
 
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