Owen Yang
There is no real point in this article. Every clinician is aware of the term ‘evidence-based medicine,’ but when you think carefully it can be somewhat confusion.
The best way to deal with this confusion is not to think about it.
Evidence-based medicine
The term evidence-based medicine is indeed confusion.
I guess nowadays evidence-based medicine simply means medicine should be firstly based on what has been shown to work, but not based on logic derivation of theories.
For example, ramipril, a drug known to inhibit angiotensin-converting enzyme, is demonstrated to lower blood pressure. What ‘really’ matters is that ramipril is demonstrated to lower blood pressure. The mechanism behind it in this simple argument is secondary. One can guess a second drug that also inhibit angiotensin-converting enzyme may also reduce blood pressure, but without it is proved, we cannot practice medicine based on logic deduction.
Theories do not always work
There are obvious reasons why simple logic deduction does not work. There are simply so many side stories that we cannot possibly think of them all. The second drug may not reach the body part (artery walls) as much as ramipril. The second drug may have a toxicity so that the safety dose may not be sufficient to reduce blood pressure. The second drug may have other properties in addition to inhibiting angiotensin-converting enzyme that may counteract with the reduction of blood pressure, for example fluid retention.
The confusion remains
In the real world, however, it is very difficult not to confuse theory and practice. You will tell yourself that this drug helps sugar excretion in the urine, which helps to control diabetes and reduce sugar level, and controlling diabetes helps to avoid further heart attack. However, not all medication that reduce sugar level can help to avoid heart attack.
A better way to communicate is that we emphasise this drug has been shown to work, and then explain why we think it might work.
