Real versus Rubbish EBM

On January 14th 2014 a number of luminaries from the Evidence-Based Healthcare world met in an open workshop to debate what Evidence-Based Medicine should be about.

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  1. The meeting was announced on the JISC Evidence Based Health listserve by Ruth Davis from the Centre for Evidence Based Medicine (CEBM) at Oxford (edited for this storify):

  2. Tuesday 14th January 2014

    Kellogg College, 62 Banbury Road, Oxford

  3. In September 2013 Trish Greenhalgh challenged Carl Heneghan to promote 'real versus rubbish EBM' on Twitter. 

  4. An example of rubbish EBM might be (for example) putting a 75 year old on statins because the guidelines say you should, with no account of their social situation, comorbidity, life expectancy etc. 

  5. Real EBM from a clinicians perspective would include taking patient values and circumstances into account alongside evidence from guidelines ­and from an organizational perspective it would include measures to avoid a managerialist, technocratic approach to promoting guideline adherence.

  6. A meeting has been set up in Oxford with the aim is to define real and rubbish EBM more rigorously.  As part of this meeting there will be an open session for all who would like to hear views on real v rubbish EBM  from the experts.

  7. Titles include:


    Carl Heneghan - Why most research should not reach the appraisal step

  8. Paul Glasziou - Using healthy skepticism in the patient's interests

  9. Jeremy Howick - A new generation of bias in EBM

  10. Des Spence - EBM as a marketing tool for Big Pharma

  11. Neal Maskrey - It is not real versus rubbish, but EBM versus EBM2

  12. Jon Brassey - An alternative system for systematic review production

  13. Richard Lehman - Patient Centred Evidence - the Unicorn that must be found

  14. Margaret McCartney - Too much treatment for the well, and not enough for the sick

  15. Mike Kelly - Philosophical reflections on rubbish EBM

  16. Iona Heath - EBM is a means – but to what end?

  17. From the listserve discussion in the days before the meeting:

    "In trying to distinguish “real vs. rubbish EBM”, have we come a full circle? Some of us have pointed out for some time now that evidence is necessary but not sufficient for decision-making. It appears to me that the conference may end up confusing evidence for decision-making (and vice versa)." Ben Djulbegovic goo.gl/HTYTsh
  18. "This is a relevant topic bringing the multiple dimensions of EBM including best evidence, decision making, social policy, equity, distributive justice  and role of population health in clinical practice." Amit K Ghosh goo.gl/qsCkPq
  19. "I ... think that perhaps the most helpful thing that might come out of this (at least from my perspective is an educator) is a short presentation or brief consensus statement, etc, on ideas for moving forwards - how to we teach colleagues and learners to think critically about getting to the evidence that will really matter to improving patient's lives?" Bill Cayley goo.gl/zO912g
  20. "It's 2014 and "from the experts" on EBM still has no patient representative and male:female is 4:1. On cultural and other diversity, well...... Four serious questions: Are the women, non-WASP and patient experts in particular really so invisible to the decision makers? Is this really what audiences want? What does this say about EBM and issues of power and privilege? Has someone got evidence that this is not a form of bias that has serious implications?" Hilda Bastian goo.gl/kAMn0C
  21. In response to Hilda Bastian: "As you may know late in 2013 Trish Greenhalgh (a vociferous critic of the "club") challenged Carl Heneghan to promote "real versus rubbish" Evidence-Based Medicine. Although his "club" was being challenged, Carl thought it would be a good idea to have a meeting between him and Trish to flesh out what they meant. Isn't it great that people from inside the "club" are open to challenges and to discussing the idea that EBM might be "rubbish"! In fact a main aim of this small meeting is to discuss how to arrange and organise a larger meeting. This small preliminary meeting will help us leverage the larger symposium. You will see calls for such a symposium in the upcoming months." Jeremy Howick goo.gl/H2QMe6
  22. "Would be also great to hear how the mechanism of guidelines construction can be easily biased when “evidence based” wording becomes a candy wrap (without evidence-based contents). Have never heard of the guidelines which would cancel and not promote dangerous treatments or excessive and invasive diagnostic procedures, apart from the two most recent ones related to breast and prostate screening which caused rogue resistance in clinical medicine." Nik (Nikita) A. Makretsov goo.gl/Lfam9N
  23. "Real EBM conscientiously critically appraises and takes account of all the relevant evidence and all the relevant values in order to support the patient or policy-maker to optimise their decision-making. Rubbish EBM does not.... Clinicians practicing real EBM need to be able to understand, identify, elicit the relevant values in themselves, their patients, and their culture. Rubbish EBM does not do this." Michael Power goo.gl/KznUQ7
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