The Pros and Cons of Evidence-Based Medicine
I have a thing for science and learning about how things work – it’s one of the reasons I became a veterinarian. I considered becoming a research scientist, but the more I dabbled in the field, the more I realized I liked “big picture” science rather than delving ever more deeply into a relatively narrow field.
Clinical practice is definitely “big picture.” Doctors routinely have to collect data from many different sources (history taking, a physical exam, laboratory tests, etc.) and come up with an explanation for and practical way to deal with a patient’s problems. Add to this already complicated situation the fact that our information is typically not complete and/or the results we have seem to contradict one another and you can see why medicine is sometimes described as an art rather than a science.
Some veterinarians don’t like this “art” aspect of medicine, though. A movement is afoot that encourages doctors to base their recommendations on the results of scientific research – so-called evidence based medicine. You are probably thinking, “Of course doctors should base their recommendations on science. Isn’t that what they already do?” Yes, when the scientific evidence exists, that’s exactly what most of us do. But as I mentioned above, we’re often in the position of having to make decisions about a particular case based on ambiguous information.
Veterinary medical research is not particularly well-funded. There’s a lot more money to be had on the human side of things (that system is far from perfect also), so it shouldn’t come as too big of a surprise that veterinarians have to get creative. We routinely use medications “off-label,” meaning to treat a disease or in a species for which they haven’t been approved. Just because something seems to work in a person or in a dog doesn’t mean it’s going to work (or even be safe) in a cat, but sometimes that’s all we have to go on.
We don’t fly completely blind in these situations. We have an understanding of the physiology of the disease and species in question, and we’ll look for case reports describing times when someone else has tried something similar and had success, but at some point you often just have to make your best educated guess and go with it. This scenario is obviously not ideal. Sometimes we’ll think, “Hey, that seemed to work well” and continue using a new therapy when any improvements we observe are simply a result of the placebo effect or something called “regression to the mean” (we tend to seek medical care when symptoms are especially bad and then credit treatment for improvement when it could just be normal variation over time).
I am a believer in evidence-based medicine, when the evidence is available. However, I can’t exactly wait for the perfect meta-analysis when faced with a sick patient on my exam room table. When the evidence is lacking and a patient is suffering, I simply have to fall back on my own experiences and those of other clinicians I trust and hope the science catches up later.
Dr. Jennifer Coates
Image: kurhan / via Shutterstock