Evidence-Based Medicine: An Introduction

The concept of evidence-based medicine.

As such, a universal definition of the term "evidence-based medicine" does not exist. He wanders from article to article, transforming according to the source, it is used. On average, evidence-based medicine - is a collective term covering methods of collection, analysis, interpretation of medical information, providing evidence-based selection of safe and effective means of diagnosis, treatment and prevention of disease. First, it should be said that the concept of "evidence-based medicine", to some extent, taken - is the English translation of «Evidence-based medicine» (EBM), proposed by Canadian scientists McMaster University in 1990. But do not put so much importance to this date, as it is not identical with the emergence of evidence-based medicine as a phenomenon. If we reject the verbal gymnastics, the principles of evidence-based medicine to some extent been used since the mid 19th century, when the "age of bloodletting," which, to this day, it was elevated to a cure, was replaced by the so-called "period of therapeutic nihilism." For doctors it is understood that the advantages of one method of treatment over another should be based not on blind adherence to "time-tested" methods, more like a shamanistic rite, and the analysis of results of clinical observations from the practical use of the compared methods. That is, North American scientists just call a spade what existed in the Old World more than a century ago.

In evidence-based medicine, and there are a lot of critics, but I think all this is a question only of not quite correct understanding of its essence. Evidence-based medicine - is not a collection of dogmas theorize allowing, roughly speaking, the conditional intern Lobanov treat any patient by opening a page of the standard treatment. Evidence-based medicine - is, first of all, the art of using their own medical knowledge and intuition, without slipping at the same time, excessive empiricism, and reliance on, of course, proven methods of treating disease.
Confirm the effectiveness of the system

Prove the effectiveness of a drug or a method of diagnosis and treatment (if we're talking about a high level of evidence according to the unified world ranking) sometimes easier than to confirm the existence of Bigfoot or the Loch Ness monster. Why? About everything in order.

In evidence-based medicine are clinical trials, ie not in a test tube or on a white mouse, but directly to the people. The basic document governing the conduct of clinical trials and binding guidance to all scientists from medicine, is the Helsinki Declaration, adopted in 1964 by the World Medical Association. On the basis of this document are local rules in clinical trials around the world, including our own. There are general principles of clinical trials. Here they are:
accountability, ie obligatory presence of a control group receiving a placebo or comparator drug ("dummy") parallel to the main group, which takes the medicine. This is in order to rule out the possibility of auto-suggestion in the treatment of this drug. We differentiate between:
single-blind study, when his party did not know exactly what it takes: the study drug or placebo;
double-blind study, when this does not know well and the doctor;
triple-blind study, when this information is hidden, including, from the head of the research;
randomized. This means that a homogeneous group of patients recruited, which is subsequently randomly divided into experimental and control groups;
mandatory compliance with all the principles and ethical standards presented in the Declaration of Helsinki.

In our country, the basic principles of clinical trials listed in the Law on Circulation of Medicines, the Rules of clinical practice in the Russian Federation, approved by Order of the Ministry of Health of 19.06.2003 № 266 and a number of other sub-sectoral legal acts.


Evidence-Based Medicine
Archie Cochrane and the Cochrane collaboration


Evidence-Based Medicine: An Introduction
Archie Cochrane

Any more or less meaningful story about evidence-based medicine can not be imagined without a mention of the man. British epidemiologist Archie Cochran (Archie Cochrane) can be called a pioneer, because it was him in 1972 had the brilliant idea to make an inventory accumulated by the time of medical information and to separate, so to speak, the wheat from the chaff, that is, methods and means of treatment efficacy proven in randomized trials, the methods, the effectiveness of which was not confirmed in this way. He perfected the technique of meta-analysis, that is statistical analysis of a set of studies, as if it were one large study. In 1993, after the death of the scientist had created "Koxranovskoe cooperation» (Cochrane Collaboration), which joined in 1999, and Russia. The main objective of the organization - helping doctors all over the world in an objective choice clinically proven drug or method of treatment. This is achieved by constantly searching and organizing information on a randomized, controlled clinical trials. Forces representatives of the organization, "Cochrane collaboration" was created Cochrane Library.


The Cochrane Library - a unique resource, a huge database of evidence-based medicine. Thus, it includes a summarized overview of randomized clinical trials, selected according to strict criteria. Simply put, not every randomized study considered to be valid and, therefore, worthy of inclusion in the Cochrane Library. In addition to the surveys, this resource contains a register of randomized controlled trials. Development and maintenance of the register prior hard work, in fact, hand searches of research publications in medical journals. In short Cochrane Library - it's just a storehouse of knowledge for each health worker, who does not just mechanically doing his job, and is committed to continually improve their knowledge and professional competence. Need only enter in the search box the name of the drug or the disease of interest - if you please: Meet, learn, and make sure to be disappointed, unless, of course, the English possess.
Examples of drugs with unproven efficacy

In this chapter, I will focus only on some of the most commonly used drugs whose effectiveness has not been confirmed by appropriate evaluation criteria from the perspective of medicine.

• Arbidol. Perhaps the most raspiarenny drug, followed by stretches unseemly trail misleading advertising, corruption suspicions, kickbacks, lobbying and revelations (remember, though, history Golikova / Pharmstandard). Meanwhile, such excitement about Arbidol has only been in our hearth and home. In the civilized world, it did not cause absolutely no interest: it is simply not considered to be a medicine. Clinical trials do not give reason to speak of its effectiveness;

• Mezim forte. How is it in advertising? "For the stomach does not change!" While it should not act in the stomach and in the intestine, where, after the dissolution of the dosage shell contained in the tablet released pancreatic enzymes that improve digestion. The catch is that the alleged manufacturer of enteric-soluble shell still in the stomach by the action of hydrochloric acid, where it is the inactivation of the enzymes contained in the pill, which makes the drug comparable to placebo.

• Corvalol. My favorite product of our grandmothers, who poured it into itself almost buckets. Try the bubble korvalola enter the U.S.: you will not work, because he simply banned in this country because it contains psychoactive component - phenobarbital. Interestingly, the phenobarbital have declared a particularly dangerous psychoactive substances, but at the same time, thanks to korvalola, valokordin and others like them, a lot of phenobarbital are uncontrolled OTC turnover. Well if phenobarbital, right korvalola and efficiency in terms of impact on the course and outcome of heart disease is clinically proven. This is - an empty shell, "non-working" drug.

In fact, drugs with unproven efficacy in abundance. By a strange coincidence, most of them are still in use at us, while in the west of them have long since abandoned or never used. We do they continue to enter the archaic standards of diagnosis and treatment of diseases, developed more in the year one. We can only hope that someday the day will come when we will be treated in accordance with international standards and criteria of evidence based medicine.

 Andrew Vitale  webmedinfo.ru