A methodology that supports better decision making in healthcare
Medical treatments are supposed to help us prevent or treat a large variety of medical conditions. Currently, less than 20,000 different treatments exist, including more than 1,500 prescription drugs1 (RX), and a similar magnitude of non-prescription drugs (also known as Over-The-Counter or OTC), surgical procedures, medical devices, supplements (such as vitamins and minerals) and alternative medicine treatments (for example – traditional Chinese medicine, herbal extracts and chiropractic). With so many existing possibilities, how can we tell which treatment is the best option for each specific patient, who suffers from a specific condition? Which treatment in a specific situation will do least harm (to begin with), and will bring the best benefit? What is the best choice?
In some cases the best option might be NO treatment at all, because there are no known treatments for the specific condition that the patients suffers from, or because the existing treatments cause more harm than good. In other cases, milder treatments provide the best options, because they help a bit, and are relatively safe. Yet in other situations, only intensive (and somewhat dangerous) medications might help, and should be applied.
So how can we choose wisely? When we use no treatment – are we neglecting our health, or actually making the right choice? When we take milder treatments, how can we or our care provider tell if the selected treatment fits our condition? And when we go to the doctor are we receiving relevant treatments? How do doctors decide what to prescribe and recommend?
Nowadays, Evidence Based Medicine (EBM) is the best method for answering these questions and for guiding our decision-making. The EBM method is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients2.
Evidence Based Medicine provides a framework for choosing medical treatments wisely, by carefully reviewing the accumulated scientific evidence about the effectiveness and safety of medical treatments. EBM is usually based on Systematic Reviews, which in turn, are usually based on all valid clinical studies (mainly RCTs – Randomized Controlled Trials). When Systematic Reviews are not available, less solid sources of evidence are considered, such as meta-analysis, specific RCTs and observational studies. The bottom line is that using EBM we inspect “what science tells us” in order to choose helpful treatments.
However, even when a treatment seems a valid solution according to science, it still may not be the best treatment for a specific patient with a specific medical background and medical condition. This is why EBM requires taking into account not only the scientific evidence, but also two other things: the experience and the diagnosis of the doctor, and the preferences of the patient.
Doctors can select between several reasonable medications based on their personal experience with other patients, and taking into account the age, gender, medical history and other characteristics of the patient. In addition, while doing so, the voice of the patient must be heard: patients may prefer one treatment to another, due to their religious and personal beliefs, sensitivity to pain, ability to pay for expensive treatments, and many other considerations. The bottom line is that according to EBM, choosing the right treatment for specific patients should combine established science with the experience of the doctor and the preference of the patient. By considering all three aspects, we highly increase the chances to choose a treatment best suited to the patient.
Evidence Based Medicine, though it had faced some criticism, is regarded as the gold standard of clinical practice and is growing in influence among doctors. However, EBM involves some complicated statistical calculations that many professionals (doctors, nurses, pharmacists and other caregivers) do not understand. In addition, Evidence Based Medicine (also known as Evidence Based Treatment) is an unfamiliar concept to the large majority of the public.
When patients choose treatments on their own (for example – treatments that do not require doctor’s prescription – such as Over-The-Counter medication, supplements and alternative medicine solutions) – they rarely use solid evidence (such as Systematic Reviews). Patients’ decisions are still based on unreliable answers they may find online or in the media. Often, patients (and journalists) read a summary of results of only one single clinical trial, and may be missing the full picture of the accumulated evidence from multiple trials.
A similar problem occurs when patients talk with doctors. Doctors may be reluctant to hear their patients’ suggestions for treatment, when those suggestions are based on unreliable information that the patients found in online searches. Moreover, patients do often look for answers about healthcare issues using online resources. In fact, 1 in every 20 searches in Google are for health-related information – more than any other search topic in Google. But when, for example, they want to check how effective and safe are the treatments their doctors suggested, they receive complex, confusing and often contradicting answers, that only rarely rely on solid evidence.
At CureFacts, we create the first ever Evidence Based Medicine platform. This platform serves as a meeting point between science, patients and doctors. The information we provide is based on solid evidence (Systematic Reviews), and is, nevertheless, presented in an accessible way to all (by including our intuitive rating, info-graphics and clear language).
CureFacts’ platform enables a respectful dialogue between patients and doctors: doctors listening to patients’ preferences, patients taking doctors’ experience into account and both doctors and patients review together the established evidence provided by CureFacts. This way, patients can choose better medical treatments together with their doctors, while using and practicing Evidence Based Medicine on a regular basis.
For further reading, see more about CureFacts’ Evidence Based Medicine platform.