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“My cardiologist was so impressed with my results. By following Dr. Dunaief ’s advice, I’ve been able to stop all three of my blood pressure medications. My heart palpitations, which were limiting my activities, have dramatically reduced in frequency, my energy levels have increased and I have lost 15 pounds in two months.”

~ Nurse, age 62

Evidence-Based Medicine

 

I often refer to evidence-based medicine when treating patients, answering questions or presenting to groups about particular therapies related to prevention and treatment of chronic diseases. 

What is it and why is it important to me?  

Evidence-based medicine (EBM) uses the latest medical and/or scientific research and expert opinion to help guide my decision-making.  EBM, in combination with solid clinical judgment, may be the most effective way to increase the probability of optimal health outcomes for patients.  With experience, I have learned how to differentiate valid research from unreliable or misguided sources1.

There are generally four types of studies that comprise the EBM field, including2:

  1. Randomized clinical trial (RCT): considered the gold standard - individuals are assigned by chance to receive one therapy or another or a placebo
  2. Prospective observational trial:  usually not as well-controlled, but still valuable, especially with a large participant population - follows individuals forward in time, observing behavior and its results
  3. Retrospective trial: provides suggestions or hints that the results may be effective - looks backward in time at behavior and results
  4. Expert perspective or opinion: may be based on the other three types of studies, on a consensus panel, or on the individual expert’s research or experience

In addition, meta-analysis, which pools data from several trials, is sometimes used; the validity of the results depends on the types of trials, how the data was pooled, and assumptions that were made in analyzing it.

I regularly read these types of studies to help ground my decision-making process.  In giving medical advice to patients on a one-on-one basis, writing a blog or column, or presenting information to an audience, I will typically cite the latest research and its impact. This allows you, the patient or audience, to validate my statements.

1. Uptodate.  Evidence-based Medicine. September 23, 2010.

2. U.S. Preventive Services Task Force (August 1989). Guide to clinical preventive services: report of the U.S. Preventive Services Task Force. DIANE Publishing. pp. 21–25.