Year : 2018 | Volume
: 9 | Issue : 2 | Page : 115--116
Evidence based or evidence biased!
Indu Bhusan Kar
Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
Indu Bhusan Kar
Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha
|How to cite this article:|
Kar IB. Evidence based or evidence biased!.Natl J Maxillofac Surg 2018;9:115-116
|How to cite this URL:|
Kar IB. Evidence based or evidence biased!. Natl J Maxillofac Surg [serial online] 2018 [cited 2019 Jan 19 ];9:115-116
Available from: http://www.njms.in/text.asp?2018/9/2/115/245355
Evidence-based medicine (EBM) is conscientious, explicit, and judicious use of the current best evidences in making decisions about the care of individual patients. It means integrating individual clinical expertise with best available external clinical evidence from systemic research. It is aimed at improving health-care standardization of practice reduction in unnecessary care and cost. Since its advocation in 1990, does EBM has fulfilled its aim?.
In my intern days, I was tempted to prescribe Dapson to a young newly married lady having Oral Lichen Planus based on evidence in the scientific literature. The couple left for their hometown with the intention of buying medicines from a known medicine shop. While dispensing the medicine, the shopkeeper the known friend of the husband was curious about the consumer of the drug and with his limited knowledge declared that the drug Dapson was specific for Hansen's disease. With this heartbreaking news, the gentleman had no option, but to send the bride to her parental place in a village scenario. I still have doubt whether the lady has a cure of her disease and back to her in-laws justifying evidence based and I curse myself for this socially not accepted regime for a bride.
The dental procedures carried in children causing bleeding is unlikely related to the intensity of bacteremia and the cumulative espouse to bacterial load was significantly greater in the daily dental procedures in comparison to the office procedures. The value of antibiotic prophylaxis before most dental procedures is questioned.
The indiscriminate acceptance of industry-generated evidence is akin to letting politicians counting their own votes for most of the drug intervention studies are industry funded. Antipsychotic medications are big business with an international market of 19.6 billion dollars and patients are often subjected to expensive treatments based on such evidence, the existence of publication bias does not uphold the scientific integrity particularly in systemic reviews and meta-analysis.
The guidelines produced in the issue of March 2018 by the ADA in the Journal of Internal medicines has drawn criticism on the issue of aggressive lowering down the normal values of blood sugar level to promote expensive multiple oral drug regimes.
The surgical removal of all the third molars on the path of evidence-based practice has cost the NHS to spend 20 million dollars annually and guidelines are now issued not to remove healthy impacted third molars.
Defining a normal man serving as a control in the research study is another impressive exercise in the present-day medicine, 5% of normal man are abnormal with false positive in the result of Hi-tech whole-body scanner out of 100 of so-called normal people have 2500 abnormalities detected without illness. One of the interesting findings in the Annals of Gastroenterology 2015 January–March 28(1) 87-93 that in the quest of understanding the pathophysiology of gastrointestinal disease where the case-controlled studies were vital, the definition of a healthy control was not clear.
Time has come for introspection the current researches “Evidence based or Evidence” biased!