Talk:Evidence-based medicine/Archive 2

Archive 1

Archive 2

Definition of EBM in lede?

Yesterday I revised the definition of EBM in the lede [1]. In particular, I replaced a source which I feel is inappropriate because it is a fairly "random" opinion article [2] by the carefully referenced entry in the current edition of the dictionary collegially produced by the International Epidemiological Association [3]. I also expanded the sentence to specify, per the Dictionary of Epidemiology source, that EBM takes into account "patients' individual circumstances and preferences"—a key point, imo, which otherwise was not addressed in the lede.

Query: Which is more appropriate for the introductory sentence? Or what might be more appropriate still?

—MistyMorn (talk) 21:43, 5 September 2012 (UTC)

This is sort of implied in EBM/EBP recognizes that many aspects of health care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBP, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable. But perhaps it can be strengthed still further, in order to hammer on the fact that science tells us only what we can do, but not what we should do. EBM tells us with better clarity what event A will likely happen if we do medical treatment B. But it's still a problem for various other political, philosophical, ethical, economic, and esthetic modes of discourse to tell us what to do, even after EBM's answers are in. It's very much the same as in (say) engineering. People give EBM more credit and more blame than they should. Engineering (by itself) doesn't tell us whether or not to build a bridge in a place, or even travel over it when it is built. That's not what EBM (or any practical science) is about. SBHarris 22:36, 5 September 2012 (UTC)

I believe the definition would benefit from being a) better sourced; b) more explicit. I considered the possibility of sourcing from one of Sackett's seminal pieces, but the Dictionary of Epidemiology source seems to me have the advantage of being both recent and collegial (as well as succinct and readily verifiable). The present source is actually not even indexed by the NCBI as a review article [4] (cf WP:MEDRS). This viewpoint article may be quite appropriate for a Criticisms section, but I don't see it constitutes the best source for the main topic definition. —MistyMorn (talk) 07:13, 6 September 2012 (UTC)

The sourcing is ultimately going to be a matter of editorial judgement rather than a black-and-white call. It's interesting to look at Sackett's article, because a lot of major EBM organizations have adopted his defintion verbatim. For example:

• Cochrane Library: "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."
• Centre for Evidence-Based Medicine: "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

Given the evidence that Sackett's definition has been widely adopted and is in current use by major EBM organizations, I'm comfortable with using it here, although of course there may be other equally valid definitions. MastCell ^Talk 18:26, 7 September 2012 (UTC)

I think that's a sound proposal which would make a valid starting point for this highly relevant page. —MistyMorn (talk) 17:58, 8 September 2012 (UTC)

I agree with this solution, and suggest using Sackett et al. (1996) plus another more current review, such as from CEBM. Thanks for the discussion. --Zefr (talk) 14:36, 12 September 2012 (UTC)

Classification?

Another inappropriate source [5] is cited to justify a presumed "Classification" of EBM. Like the viewpoint article from the same journal currently used to source the main definition of EBM in the lede, this article (albeit highly respectable) does not technically satisfy WP:MEDRS. More worryingly, our text does not seem to reflect the content of the original article [6]. According to the author of this viewpoint article from 2005:

This paper describes two main ways evidence is being applied to improve health care, argues that both are necessary, and offers a new definition of EBM that better captures how it is actually being applied. ... It seems obvious that the current definition of evidence-based medicine, which focuses on individual physicians and their decisions, is too narrow. It should be expanded to include not only evidence-based decision making by individual physicians, but also evidence-based systematic reviews, guidelines, and other types of policies. ... In summary, EBM is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit.

That is not the same thing as proposing a classification of EBM (and a proposed classification is not the same thing as an accepted classification).

Does any received classification of EBM exist? I suggest the present section is WP:SYNTH.

—MistyMorn (talk) 11:03, 7 September 2012 (UTC)

Sowhat? Anything in WP not directly copied or plagarized is something that has been summarized or abridged, and doing that requries the judgement of the writer about what to put in and leave out. That is WP:SYNTH. "Oh, no!" you say. It's impossible for WP to make a rule which it is forced to break in every article, and not have every editors' head explode with cognitive dissonance!. Well, that's organized religion and cults for you, my child. Which WP is. Faith is not in moving mountains, but in failing to actually note it, when mountains move. SBHarris 23:48, 8 September 2012 (UTC)

Clearly, my concern is that Wikipedia may be propounding something which doesn't actually exist. Please be civil. —MistyMorn (talk) 08:49, 9 September 2012 (UTC)

Clearly, you should have done an internet search before worrying about this, in this case. [7][8]. It's pretty rare to find standard web tutorials from major universities about something that doesn't exist. No, there isn't perfect agreement, but then few subjects enjoy that. SBHarris 20:52, 10 September 2012 (UTC)

Before lecturing me on what I "should have done", please explain what connection you see between those two links and the claimed Classification. I can't see any. As you know, the term classification is not synonymous with concept. —MistyMorn (talk) 21:14, 10 September 2012 (UTC)

It is the case (see my links provided) that EBM is a praxis, or way for individual doctors to practice medicine. At the same time, EBM is also a set of guidelines for doing the same, and a number of formal guidelines for doing this also exist. Wiley EBM Guidelines,National Guideline Clearinghouse (for EBM),Dartmouth EMB database, and so on. EBM is both a practice and a theory. Now, what is your problem, here? The individual praxis is not the same as the guidelines for the same, which exist at a metalevel. They are two different concepts, one at the level of practice, one at the level of theory. Now, is it the case that you are arguing that a Wikipedia article cannot discuss a medical practice as being classified at the level of individual practice vs. a didactic guideline for that practice, without having some scholarly body formally do this division FOR us? I hope that isn't what you're saying, because that is ridiculous. As author/editors here, we have complete freedom to discuss any concept that is fit for this encyclopedia, in terms of any such intellectual division we choose. Be it practicing medicine or tying your shoes. Sorry, but you're just being obsteperous here without good reason. In theory there's no difference between theory and practice, but in practice, there is. And on WP we can discuss that difference for any wiki subject we please, and do it with editorial control which needs absolutely no permission from anyone. We get to decide where to split paragraphs, too! SBHarris 23:41, 10 September 2012 (UTC)

"Obstreperous"? Who are you calling obstreperous and why? Since when has civil objection to a Wikipedia page inventing a Classification been disruptive? If you do not respect Wikipedia policies and guidelines designed to protect Wikipedia from such unencyclopedic content [9], then that's your business not mine. You have no right to be uncivil to an editor who is genuinely trying to improve a page which has been ranked 'C-Class' and 'High-importance' by WikiProject Medicine. —MistyMorn (talk) 13:46, 11 September 2012 (UTC)

All long WP pages invent "classifications" for their subject matter-- that is what the subheadings consist of. Nor are there many long articles for which all these subheadings can be rigorously defended. Many other subject headings and classification of the subject material could have been invented. An example is United States of America, which is the most often visited non-WP page on en.wiki. The history is divided, at one point, into a period lasting from 1860 to 1914, called "Civil war and industrialization". Is that a universally recognized period that US history is classified into? I don't think so. But there are no universally recognized large periods in which to classify US history. So the authors of this article chose one conventient to them. Had I been writing it, I would have had a stopping point at 1890, when the Western frontier was officially closed, and Wounded Knee became the last great US/Native battle. But somebody else's choice here is fine. I'm under no illusion that having WP divide this will make anybody think that this is any kind of official historical division. Readers are smarter than that. The same is true in this article-- if it says that a division has been proposed, and then this division is discussed, there's little danger than anybody will think it's a anything official, and there's little intellectual danger even if they do. This is just not important enough to spend that much time about.

Speaking of which, I see that you have spent the most time of all in your WP career writing on Jimbo Wale's TALK page. [10]. You spend far more time on Jimbo's TALK page than your own, and more time there than on any article. So what do you think you're accomplishing there, and what is it that you care about here on WP? My experience is that people who hang out on Jimbo's TALK page are Wales brownnosers. Would that perhaps describe yourself? If you do the same check for me, you wouldn't find me spending most of my time on anybody's talk page but mine. I'm working on writing an encyclopedia. I have no idea what YOU are doing. I do know that you have 5000 edits or so, and you've been working as hard as I have at writing, for only about 18 months (most of the time, you've done little). Why don't you give it a few years more, get up to my own edit and article counts, and see if you've learned something? And try staying out of WP politics. Meanwhile, I'm not taking you seriously. Sorry. SBHarris 23:38, 11 September 2012 (UTC)

See WP:NPA. As I've written on your talk page, I refuse to be bullied away from editing this page. —MistyMorn (talk) 12:36, 12 September 2012 (UTC)

I have a vague interest in EBM, and so have this on my watchlist. I was curious why it kept popping up, and have skimmed the discussion. The distinction seems useful to me, and it does seem that there's evidence for its usage. Would it help to change the heading? Such as "Approaches" or "Applications of evidence based medicine"? TimidGuy (talk) 14:22, 12 September 2012 (UTC)

I agree that differences in approach deserve some discussion. I also think some consideration is needed in the main text of the definition of EBM (and key differences in the definitions that have been proposed). Please see my proposal below. —MistyMorn (talk) 14:32, 12 September 2012 (UTC)

Proposal

(edit conflict) In addition to the unprovoked character of User:Sbharris's unfounded personal attacks, his blog-like comments and refusal to engage with Wikipedia's editorial policies undermine his opposition to removing the Classification section.

Given the lack of reliably sourced evidence directly supporting the existence of any widely recognized classification of EBM, I propose replacing the present Classification section with a new Definition section. —MistyMorn (talk) 14:24, 12 September 2012 (UTC)

I'm glad that you agree that it's useful to make the distinction that's being made in the current Classification section. It does seem like your proposal could satisfy both you and SBHarris. TimidGuy (talk) 15:12, 12 September 2012 (UTC)

• I support this proposal based on the precedent set by other articles of including a definition section. Sources would be supporting justification for an unorthodox classification section and there are no presented sources. Blue Rasberry (talk) 15:27, 12 September 2012 (UTC)

Agreed and supported. Fyi, a scholarly perspective published in June 2012.[11] --Zefr (talk) 17:50, 12 September 2012 (UTC)

Yup, I feel the article structure also needs a container/section to outline the ongoing and historical debate within the EBM community (the current Limitations and criticism section is composed of a list of unfocused statements, imo). —MistyMorn (talk) 18:35, 12 September 2012 (UTC)

I'm not married to the word "classification" as a header, and won't object if it is removed. If the text notes that there is actually a difference between what individual physicians do as a practice, and a systematic attempted academic or advocated formal system to attempt to get physicians to do it, as a matter of formal "good practice," then I'm happy with this observation of a difference in levels of thinking, no matter what you may call it. There is a differences between individual practice philosophy, and formal professional guidelines which end up being more often somewhat coercive. So how to note this difference? That's up to you, so long as you do it. To paraphrase T. Roosevelt, it hardly matters if you have Tweedledum but your political or debate opponents will not be placated, unless you agree to call it Tweedledee. It's the same thing either way. SBHarris 21:48, 12 September 2012 (UTC)

Thanks for agreeing to this proposal. Perhaps Misty could draft the new definition section on the talk page that includes the distinction made in the current classification section, and then we could give feedback. Thanks, Misty, for your proposal for moving forward. TimidGuy (talk) 09:42, 13 September 2012 (UTC)

I too thought we might try to do this gradually, in a collegial way, starting with a sentence on how Sackett's statement has been adopted by major EBM organizations, per MastCell's helpful post above [12]. I feel the different approaches referred to in the current so-called Classification section should come later (not necessarily in the Definition section. —MistyMorn (talk) 09:57, 13 September 2012 (UTC)

Goodbye cruel EBM

In an irony that those of you who appreciate irony will appreciate, MistyMorn has gone straight to AN/I to complain that I'm harrassing him by being uncivil. [13]. There, he found three admins friendly to his cause (two of them VERY friendly), and so it becomes clear that I'm not going to be able to edit here, as I would continue to have to say uncivil things about MistyMorn's lack of knowledge of the subject, and I probably will be blocked for that. So, I'm going to leave this article strictly alone and go back to the science pages, leaving MistyMorn as your local expert. Warning: be nice to him. Or it will be you next, that he tells Big Brother on. SBHarris 00:13, 14 September 2012 (UTC)

Analogy with engineering

I feel like the lead is working pretty well. Each time I come to the technical fields/engineering analogy in the third paragraph, though, I get bogged down. As a reader, I'm just starting to get my head around what EBM is, and not being familiar with other technical fields, the analogy, for me, actually interferes rather than helps. It seems like that paragraph would read a lot better without these three phrases:

• , like other sources of applied technical knowledge (for example, engineering)
• Like engineering,
• , like all technological knowledge

Eager to know what you think. TimidGuy (talk) 10:58, 15 September 2012 (UTC)

Short answer: Agree! —MistyMorn (talk) 20:21, 20 September 2012 (UTC)

Thanks. Now that that's been improved, and your definition added, it seems to be working pretty well. Just skimming the article it seems to be in better shape than many WP articles. What else do you feel needs attention? TimidGuy (talk) 10:03, 21 September 2012 (UTC)

Well, for a start, rather than place quite so much weight on "engineering" [14] I think the page needs to at least make some mention of the concept of "clinical epidemiology" [15] (though at present Clinical epidemiology is a redirect to a page which doesn't even mention the term in its main text).

I think this consideration illustrates a more general problem of lack of focus in the current version of this page. I wanted to start work on rectifying this shortcoming gradually, hoping to work constructively with others with a genuine NPOV interest in the subject using high quality sources throughout. I have to admit the insults and bad faith that have been hurled at me above, elsewhere and behind my back have somewhat chilled the pleasure of contributing.

I continue to think this is a highly relevant page which needs improving.—MistyMorn (talk) 13:01, 24 September 2012 (UTC)

I for one am not wedded to an explicit Engineering analogy. I believe it was an attempt to evoke a pattern of concepts. So let's try (on this talk page first) to make explicit the hierarchy/network of concepts. You suggest that Clinical Epidemiology (CE) is a key relation of EBM, and you point out that there is no Wiki article for it. Perhaps if one were created (even just a stub as a node in the concept network) it might make the relationships clearer. I have raised that possibility on the Epidemiology(talk) page. And started preparing the ground on Clinical(talk) - right now the word opposed is used rather loosely.

Meanwhile, based on a reading of the reference you provided above, we appear to have: Clinical Activities or 'medicine' (CA) -> CE (Epidemiological methods applied to CA) -> EBM (leveraging CE results to improve the CA) in a virtuous circle or positive feedback loop. Is that right? Shannock9 (talk) 17:44, 24 September 2012 (UTC)

Yes, I'd say that's the rationale, succinctly put; of course there are also other concepts in the net...

Unfortunately, there is no dedicated Epidemiology wikiproject or taskforce and your Epidemiology talk page post appears to have been the first there for over a year [16]. Anyway, I think it was a good idea to raise there the Clinical epidemiology query ([17] [18] [19] [20]). Given the limited activity at Epidemiology, maybe it would be good to raise the matter at the WikiProject Medicine too, at WT:MED? —MistyMorn (talk) 20:14, 24 September 2012 (UTC)

Thanks Misty. Just to say that I will not be able to do much on Wikipedia for about a week due to being on the road. So no-one should feel ignored. Nor of course should they wait for me before going bold :) Shannock9 (talk) 16:39, 26 September 2012 (UTC)

Idea flow in introduction

Because the predictive approach EBM/EBP is used in allied fields, including dentistry, nursing and psychology, evidence-based practice is a more encompassing term.

I had to read this four times (suspecting a 'missing verb') before I realised that you have conflated two unrelated statements (a) EBM/EBP can be used predictively (b) EBP is more encompassing. I suggest you slip in statement (a) much earlier as follows

This helps clinicians predict whether or not a treatment will do more good than harm.

leaving

Because the EBM/EBP approach is used in allied fields, including dentistry, nursing and psychology, evidence-based practice is a more encompassing term. Shannock9 (talk) 01:45, 20 September 2012 (UTC)

Excellent point. Will try to fix. TimidGuy (talk) 11:07, 20 September 2012 (UTC)

Nice fix Tim (well he would say that, wouldn't he?) - Thanks Shannock9 (talk) 19:09, 20 September 2012 (UTC)

[Note: "Lede" is a neologism originating in the journalism industry meaning the first one or two sentences of a news story, and never more than a paragraph. We use "lead section" or "introduction" to mean the multi-paragraph first section. I've edited the header of this talk page section to keep my watchlist from driving me nuts about this. —Cupco 19:39, 20 September 2012 (UTC)]

Whatever the spelling, it would be great to improve the Lead. And indeed the rest of the page. —MistyMorn (talk) 20:18, 20 September 2012 (UTC)

"Process and progress"?

Never been sure quite why we've got this catchy sounding title [21] here. Maybe this section could be merged with the belated "History" one? —MistyMorn (talk) 11:16, 21 October 2012 (UTC)

Criticism section

Is this Evidence-based_medicine#Limitations_and_criticism section not undue? Some of the text I don't even know what the criticism is exactly: "In areas where frames (contextual and presentational influences on perceptions of reality) obscure facts, hypocognition has been blamed for preventing the practical application of EBM". IRWolfie- (talk) 20:53, 10 November 2012 (UTC)

In practice, think the presence of a "Limitations and criticism" section is an invitation to bundle bits of informed historical debate from within the scientific medical community (material which should be woven into other sections, imo) together with... well, whatever... (a bit like at 2 min 35 sec on the podcast here [22]?). For example, the "point" that Not all evidence from an RCT is made accessible is a bugbear which the EBM community has tried to address, in part at least, by incentivating trial registration and trying to encourage database sharing for pooled analysis. As regards the hypocognition sentence (WP:WEIGHT?), the source [23] again seems to be a genuine contribution to debate.

Imo, more informed involvement is needed on key topics such as this, Clinical epidemiology (currently a relatively uninformative redirect), Meta-analysis (2 cents here [24]), etc. Some sort of a taskforce (or similar [25]) would be the ideal, but success would require more human resources and momentum. Suggestions? —MistyMorn (talk) 13:33, 11 November 2012 (UTC)

Perhaps we could ask for help via letters to journals, like EBM and Journal of Clinical Epidemiology. I'd be very happy to work with authors, guiding them in our content policy and style. --Anthonyhcole (talk) 14:11, 11 November 2012 (UTC)

Alternative medicine article discussion to restore MEDRS and NPOV content and sources such as Annals of New York Academy of Sciences and Journal of Academic Medicine

A discussion to restore the first 14 sources of this version, including Journal of the Association of Medical Colleges, Annals of New York Academy of Sciences, Academic Medicine, Canadian Medical Association Journal, Medical Journal of Australia, Nature Medicine, etc., to the Alternative medicine article is now going on here. ParkSehJik (talk) 02:57, 22 November 2012 (UTC)

Increasing the heading level of GRADE

I propose to increase the heading level of GRADE Working group up by one.I propose this because of two factors It takes on both grading quality of evidence as well as making recommendations. It is gaining wider recognition and importance because it is more simpler, intuitive and more generalizable. Agencies like the WHO and the Cochrane Collaboration have adopted GRADE as the standard way of grading quality of evidence and making recommendations. — Preceding unsigned comment added by Manum56 (talk • contribs) 13:13, 8 December 2012 (UTC)

The URL in

Schünemann H, Brożek J, Oxman A,, ed. (2009). [Available from http://www.cc-ims.net/gradepro GRADE handbook for grading quality of evidence and strength of recommendation] (Version 3.2 ed.).

is only satisfied at archive.org . From a google search this PDF http://www.who.int/entity/hiv/topics/mtct/grade_handbook.pdf is a copy and the NCBI book http://www.ncbi.nlm.nih.gov/books/NBK43214/ GRADE Tables, Assessing the Evidence - Comparative ... These seem to be the current URLs for GradePro http://ims.cochrane.org/revman/gradepro http://ims.cochrane.org/revman/other-resources/gradepro/resources . RDBrown (talk) 20:08, 8 December 2012 (UTC)

Disambiguation?

Should/could someone do a disambiguation page for EBM (as in this vs Electronic Body Music). As an ortopaedic surgeon who listens to EMB while doing clinical research this coincidence of abbreviations is fine, but perhaps a disambiguation page would be useful. Personally can't just spare the time. — Preceding unsigned comment added by 88.114.215.145 (talk) 20:28, 12 February 2013 (UTC)

Already exists, at EBM. 81.98.35.149 (talk) 21:32, 18 February 2013 (UTC)

Source

This article could make good use of: Woolf S, Schünemann HJ, Eccles MP, Grimshaw JM, Shekelle P (2012 Jul 4). "Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations". Implement Sci. 7: 61. doi:10.1186/1748-5908-7-61 pmid= 22762158. PMC 3436711. {{cite journal}}: Check |doi= value (help); Check date values in: |date= (help); Missing pipe in: |doi= (help)CS1 maint: multiple names: authors list (link) LeadSongDog come howl! 17:14, 22 February 2013 (UTC)

deletion

The para deleted today appears to have originated in this edit way back in 2006. Might still be worth asking the contributor...LeadSongDog come howl! 00:08, 10 June 2013 (UTC)

Yeah, this appears to be a good description. Don't understand why it was deleted. I am trying to fit it into the current version. Manu Mathew (talk) 02:41, 6 December 2013 (UTC)

Redirects

Would it be beneficial to create redirects to this page? There are several alternative names for EBM - Some of them are Evidence Informed Healthcare (the current standard name), Evidence Informed Policy, Evidence Based Healthcare, Evidence Informed Decision Making etc.Manu Mathew (talk) 12:53, 8 December 2013 (UTC)

Yes redirects for terms that mean the same are key. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:10, 8 December 2013 (UTC)

Definition of "evidence" based medicine

I check here after a few months and my comment is gone, but it was serious. Some of the definitions are applied to individual patients, others to populations. The article should address overwhelming scientific evidence that the planet cannot support the current quantity of human beings in the long term, and uncontrolled human reproduction should not be encouraged. However "evidence based medicine" tells us we need to helping those people who cannot have babies have triplets etc, and we should be saving every life no matter how useless, or indeed harmful that life might be to the species as a whole. In this respect, there is no evidence for evidence based medicine and it is instead operating at a very simplistic moral level, while ignoring major evidence that is visible to all. — Preceding unsigned comment added by 188.29.84.50 (talk) 19:39, 19 June 2014 (UTC)

History section needs surgery

The first three paragraphs of the five-paragraph History section are on topic, interesting, and well written, and I can build on these solid foundations in future edits, as I've been following the development of EBM since the first series of JAMA articles in the early 90s.

But the following two paragraphs are off topic and not up this article's standard, nor Wikipedia standards. While perhaps providing valuable content on genetics and molecular pathology, they are: (1) misplaced in this article's History section, (2) excessively wiki linked ("concept" etc.), (3) unnecessarily technical in this History section context, (4) under sourced, and (5) lacking a clear, referenced statement of context to EBM history. They were a very jarring stylistic and topic jump from the first three paragraphs on EBM history proper.

The final two paragraphs might: (a) be deleted without any loss to this section on EBM history, (b) find a context in another article, or (c) be split into a separate section (Developments?) of this article, either before or after some seriously needed rewriting, sourcing, and copy editing. As I won't personally do (b) or (c), unless the original editor (or others) choose to do one or the other themselves, I favor option (a). -- Paulscrawl (talk) 20:23, 14 July 2014 (UTC)

 Done - after two weeks notice. Paulscrawl (talk) 01:47, 31 July 2014 (UTC)

History and Wikipedia's Conflict of interest Policy

I would like to remind both new and old editors of the Wikipedia:Conflict of interest policy. I'll mention no names. I would be happy to help those affected work around the limitations this policy may put on their ability to contribute in good conscience and to good effect. Your knowledge is valuable, but it must meet the above guidelines, ensuring both notability and verifiability, among other criteria. Let's use our Talk pages, as well as this page, your choice, to work things out.

A better developed and neutrally sourced history section, moved near the top of the article, might go a long way towards helping organize this article on relatively objective lines of the actual historical development of the field. This alone might help prevent this article from remaining what it has devolved into, a series of largely disconnected special pleadings, self-sourced (WP:PRIMARY), for particular national, institutional, and perhaps even personal research programs, all possibly seeking to define the contentious field in their own image.

We must do better.

I'm adding a Find template at the top of this Talk page header as a reminder of what disinterested objective research means and to help enable anyone to separate peer-reviewed developments in evidence-based medicine that meet WP:NPOV guidelines for notability and objectivity from what amounts to PR releases.

WP:SECONDARY is a key distinction for something of such significance as evidence-based medicine. Let me know if I can help you find them. Paulscrawl (talk) 02:37, 31 July 2014 (UTC)

Psychiatry Section

Interesting paragraph. The only comment I would query would be that mental illness may be too complex to fit within diagnostic models. I think that's what it's saying.

However, (some) mental illness is either a disease with a biological correlate to the the symptoms - either known, partly known (delirium, vascular dementia) partly guessed at (schizophrenia) or living in hope that the pathophysiology will be understood one day.

Or (some) mental illness is a social / cultural construct. Even in this case we should be able to recognise the features that lead to it and create some kind of taxonomy based on this (e.g. personality disorder).

In neither case should it be too complex to be diagnosable. Just sayin. 194.176.105.153 (talk) 20:47, 13 December 2013 (UTC)

17:54, April 16, 2014‎ Zefr changed my edit in two locations to say "One study", implying it has not been substantiated. I could cite other examples ( to refute the "one study" addition) but this would mess up the article, what do I do? Should I put in more references to studies?--Mark v1.0 (talk) 17:17, 19 April 2014 (UTC)

Now the editor Zefr has removed historical evidence ,references to studies from many years ago, that shows psychiatry knew about the problem of the efffectiveness of antipsychotics for a long time.--Mark v1.0 (talk) 19:44, 22 April 2014 (UTC)

Mark -- I felt the use of historical references was more about documenting psychiatric diagnosis and treatment than it was about giving an example of how "evidence-based medicine" is applied in clinical practice. I think we should limit the exhaustive use of historical references but rather show the Article user that psychiatry is a discipline where evidence-based medicine is at a premium for making difficult diagnosis and treatment. Psychiatry is only one example among many in the medical field. --Zefr (talk) 20:13, 22 April 2014 (UTC)

Zehr The 1970's psychiatry references you removed show "evidence based medicine" was NOT used by psychiatry. The result today is the high percentage of population that is mentally ill. I think the failure of psychiatric drugs and ignoring the historical studies/evidence is a perfect example to show the importance of using "evidence based medicine".--Mark v1.0 (talk) 12:44, 23 April 2014 (UTC)

Historical articles that showed problems with the medications. "One Year After Discharge: Community Adjustment of Schizophrenic Patients" 1967 NINA R. SCHOOLER; SOLOMON C.GOLDBERG; HELVI BOOTHE; JONATHAN O. COLE . http://ajp.psychiatryonline.org/article.aspx?articleID=150571

"Relapse in Chronic Schizophrenics following Abrupt Withdrawal of Tranquilizing Medication" 1969 ROBERT F.PRIEN,JONATHAN O. COLE and NAOMI F. BELKIN http://bjp.rcpsych.org/content/115/523/679

"Discontinuation of Chemotherapy for Chronic Schizophrenics." 1971 Prien RF, Levine J, Switalski RW. http://www.ncbi.nlm.nih.gov/pubmed/4992967

"Are there schizophrenics for whom drugs may be unnecessary or contraindicated?" 1978 Rappaport M, Hopkins HK, Hall K, Belleza T, Silverman J. http://www.ncbi.nlm.nih.gov/pubmed/352976

"Maintenance antipsychotic therapy: is the cure worse than the disease?" 1976 Gardos G, Cole JO. http://www.ncbi.nlm.nih.gov/pubmed/2021 --Mark v1.0 (talk) 14:59, 23 April 2014 (UTC)

"It seems paradoxical that drugs that ameliorate acute psychotic symptoms over the short term will increase the likelihood that a person diagnosed with schizophrenia will become chronically ill. But that disturbing fact showed up in the very first outcome studies, and has continued to show up in outcome studies ever since." wrote Robert Whitaker. --Mark v1.0 (talk) 14:45, 24 April 2014 (UTC)

The "Psychiatry" section has been deleted by "Formerly 98" who followed me here from another article .--Mark v1.0 (talk) 16:28, 8 September 2014 (UTC)

Resolved: I made a section titled Evidence based psychiatry. It has plenty of references so I don't think the whole thing can be deleted.--Mark v1.0 (talk) 18:17, 16 October 2014 (UTC)

Whoooa there. This psychiatry section is totally not right for this page. Evidence-based medicine refers to the modern standard of medicine that relies on evidence gathered through research and clinical trials in making health care decisions. This is different from the more specific movement of evidence-based psychiatry. This entire psychiatry section would probably belong better in the "controversies" section of the Psychiatry page, if this info isn't already there. Dustinlull (talk) 15:22, 17 October 2014 (UTC)

I disagree with you Dustinlull. Psychiatry is a branch of medicine and follow your statement "relies on evidence gathered through research and clinical trials " . Unless evidence-based psychiatry deserves its own Wikipedia page like Evidence-based_dentistry.--Mark v1.0 (talk) 18:49, 17 October 2014 (UTC)

My issue is that this section has nothing to do with how psychiatry relies on evidence gathered through research and clinical trials. Instead, this section is very anti-psychiatry. It doesn't say anything about how psychiatry is evidence based, which is the topic of this article. Instead, this section is a list of criticisms of modern psychiatry. For this reason, it seems like it would fit better in the "Controversies" section of the psychiatry page.Dustinlull (talk) 04:30, 18 October 2014 (UTC)

I have to agree with Dustinlull. While the section itself might not be completely out of place here (unless you have enough material to write a separate article), I think there is ways to improve it. For instance, how has evidence improved the practices of psychiatry in the past? Are the criteria for EBM detailed above applied in the same way in psychiatry or are there exceptions/additions? Then you can mention which practices in psychiatry are not evidence-based. I think the main issue of this section is that there is no "point" to it. It's a list of things and only overarching theme I can see is that "psychiatry is bad". So I would probably polish this section up a bit with information that is relevant to the article (evidence-based medicine) or move it to the 'Controversies' section and shorten it. Sutefu (talk) 13:19, 18 October 2014 (UTC)

First Dustinlull wrote 04:30, 18 October 2014 "It doesn't say anything about how psychiatry is evidence based". To start off with, there is no physical evidence of disease in the mentally ill. The evidence that a person is mentally ill comes from the opinion of a psychiatrist that has an interview with said person. So in strict theory of "evidence based medicine" , psychiatry would not exist. If a doctor found no disease in their patient they would tell the patient that they are healthy. I feared a criticism of "point of view" writing, so I wrote a history of published criticism of psychiatric opinion.

Second Sutefu wrote "how has evidence improved the practices of psychiatry in the past?" I have the inverse. I have evidence , psychiatry/medicine has historical evidence the practice of psychiatry has worsened the health of the mentally ill. As you both (Dustinlull+Sutefu) do not like a negative example of evidence based medicine ( to prove a need for evidence based medicine), I will make a Wikipedia article with the title ASAP.--Mark v1.0 (talk) 14:35, 18 October 2014 (UTC)

I don't think it's about "liking" it or not, it's about amalgamating the information available to provide a non-biased overview of a topic. Your section does not explore or even mention the opposite (that evidence based psychiatry is a thing), which makes it seem biased. If scholars have explored the topic of evidence-based psychiatry (pro or con), there should be papers on it. You provided some, but have you looked into the other side of the debate? Anecdotes such as the financial links of the DSM4 panel are completely out of place and have nothing to do with the topic of the article. Sutefu (talk) 11:01, 19 October 2014 (UTC)

In the section there is text written "Council for Evidence-based Psychiatry (C.E.P.)".

Robert Whitaker a writer in the section, has found medical references that prove psychiatric patients are getting worse.

As I stated in my previous comment, psychiatric diagnosis are a psychiatrists opinion, so the financial links to the DSM are directly linked, because what happens after a psychiatric diagnosis? The patient gets a prescription to fill out at the pharmacy.

The other side of the debate would be what? psychiatric patients are getting better? First we have multiple documented proof of brain shrinkage from the psychiatric drugs, Second we have a twenty five year average shorter life span, Third the rate of mental illness in the population has increased since modern science of 1955. So I can not perceive the average mentally ill patient of today, getting better treatment.--Mark v1.0 (talk) 13:55, 19 October 2014 (UTC)

Mark, I think much of the information you have gathered here would be perfect on the Psychiatry page, in the Controversies section. But I think you might be misunderstanding what the topic of the Evidence-Based Medicine article is. "Evidence-based medicine" does not mean "modern medicine" or "Western medicine." Instead, it refers to a broad philosophy of how the field of medicine should make decisions. You seem to be saying that the field of psychiatry is not evidence-based. If this is the case, then why are you writing about it in the Evidence-Based Medicine article? If you believe that psychiatry is a flawed field of medicine, then naturally you should write about that in the Controversies section of the Psychiatry article.Dustinlull (talk) 14:05, 19 October 2014 (UTC)

My personal opinion does not change the existence of "Council for Evidence-based Psychiatry (C.E.P.)" that is in the section. I did not invent/create C.E.P. . No I am not saying "psychiatry is not evidence based", there is plenty of evidence. I am not anti-psychiatry any more than I am anti-gynaecology.--Mark v1.0 (talk) 14:51, 19 October 2014 (UTC)

Well said. I think that's the best way to resolve this. TimidGuy (talk) 14:51, 19 October 2014 (UTC)

Upon reviewing the sources for the sentence about "evidence based psychiatry," I'm surprised to see that this term is not found in any of them. Evidence-based psychiatry is not a defined term or organized movement. Basically, you're just saying that in order for psychiatry to be evidence-based, it should be more critical of psychotropic drugs. Ok, fine. There are plenty of sources for that point of view, and they should all go in the Controversies section of the Psychiatry page. They do not belong on this page. Dustinlull (talk) 14:10, 20 October 2014 (UTC)

I do think giving the Council for Evidence-based Psychiatry http://cepuk.org/ its own wiki page may be appropriate. Dustinlull (talk) 14:38, 20 October 2014 (UTC)

This needs the NPOV to be fixed as well.

Consider moving this article to the title Allopathy and stop calling it "evidence-based", because allopathy is primarily fueled by drug companies, not science. --Young Naturopath 01 (talk) 23:53, 21 March 2015 (UTC)

Heaping on some WP:UNDUE doesn't help WP:NPOV. In journalism they call that the false balance flaw. Yes, conflict of interest will always be part of life, to be monitored and managed and proportionally countered, when any organization—any organization—has deep pockets. Yes, science has brought some mistakes along with its successes. Most of the mistakes resulted from scientism and reductive excesses, i.e., enthusiasts deciding that "now science knows everything" when it really didn't (examples include DDT, thalidomide, nuclear reactor designs that couldn't handle big emergencies, and others). Which is tragic because it provides fuel or ammunition for antiscience as a reaction, which is a "cure" that is worse than the illness, quantitatively. But you know what? When your own life depends on the benefits that science has achieved, you tend not to think that antiscience is the answer to everything. People with diabetes mellitus appreciate the fact that insulin, sulfonylureas, and thiazolidinediones have been discovered and made available. People with bad infections kind of don't mind that antibiotics have been discovered and made available. Funny how one's prioritization capability can be sharpened when untimely death is one of the options. Not everyone is buying what pseudoscience and antiscience are selling. Speaking of conflict of interest. Even a proselytizer has a psychologically vested stake in persuasion, if only for his ego albeit not for his pocket. Quercus solaris (talk) 16:34, 22 March 2015 (UTC)

Limitations and criticism section can easily be organized in 5 topical paragraphs following intro paragraph & categorization scheme

At present, the criticism section is largely a hodge podge bulleted list. Helpful categorization schemes for peer-reviewed published objections to EBM exist; I've added two widely-cited ones to the intro that might help. Cohen et al. esp. might be used to render the list in several well organized paragraphs. Paulscrawl (talk) 20:50, 3 May 2016 (UTC)

Feel free to work on it. TimidGuy (talk) 16:01, 4 May 2016 (UTC)

What is wrong with the medical articles?!

What is wrong with the medical articles?! They are filled with pro-industry stuff. GetResearchFunction (talk) 16:08, 1 December 2016 (UTC)

article would benefit from better contextualization

Much of this article is an establishment of the historical significance of this seemingly redundant terminology. The term "evidence-based medicine" is itself liitle more than the hypothesis that scientific methods are utilized in generating clinical guidelines. Epidemiology is nothing more than the utilization of statistically meaningful analysis. Medicine can not be considered scientific until appropriately powered statistical methods are employed. That is a basic scientific fact in the hard, pyhsical sciences that is a fundamental part of its practice, evolving with it from its very beginnings.

The elephant in the room is that medicine has a long history of being presented as "scientific" when it is not. The term "evidence-based medicine" does not signify any development or unique approach (except for the naive) - it is nothing more than an adopted terminology utilized to rhetorically claim what was already being done, and to rhetorically distinguish from the vast amount of medicinal "science" that has been revealed as not scientific at all. Wikibearwithme (talk) 19:02, 2 May 2016 (UTC)

By indulging the narrative that someone in medicine coined the term "evidence-based" and other historical narratives that suggest this terminology represents a scientifically unique approach, the article is dancing around the issue of what the apparent need to adopt this seemingly redundant terminology says about the (still statistically abused) field of medicine. When a term is broadly utilized for rhetorical purposes, in what is claimed to be science, an honest discussion of that term should include this rhetorical context. Wikibearwithme (talk) 19:51, 2 May 2016 (UTC)

Thanks for sharing your input. These may indeed be valid points. Note, though, that Wikipedia follows what the sources say, per WP:NOR. If there are sources that make these points, then this could be added to the article. If a preponderance of sources represents the view you articulated, then the point of view of the article could be shifted. TimidGuy (talk) 14:10, 3 May 2016 (UTC)

These are not valid points. Wikibearwithme's comments skirt the actual history regarding David Sackett's early writings on Clinical Epidemiology and ignore the major shift to clinical practice based on research findings between the 1990's and the early 2000's. These are accepted and practiced by the majority of medical schools in the United States and are reflected by the materials tested by the United States Medical Licensing Examinations (USMLE). — Preceding unsigned comment added by 2601:14F:8101:9D13:D875:1E20:B2EC:6DFE (talk) 16:19, 19 June 2017 (UTC)

25 years

Lancet doi:10.1016/S0140-6736(16)31592-6 JFW | T@lk 11:05, 21 July 2017 (UTC)