Is the evidence-based medicine movement counter-productive: are randomised controlled trials the best approach to establish evidence in complex healthcare situations?

Jacups, Susan P., and Bradley, Clare (2023) Is the evidence-based medicine movement counter-productive: are randomised controlled trials the best approach to establish evidence in complex healthcare situations? Public Health Research & Practice, 33 (1). e3312303.

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Abstract

In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with ‘objective’ evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants’ health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.

Item ID: 78368
Item Type: Article (Research - C1)
ISSN: 2204-2091
Keywords: Aboriginal and Torres Strait Islander Health, Evidence informed policy and practice, Research governance and design
Copyright Information: © 2023 Jacups and Bradley. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.
Date Deposited: 11 Oct 2023 01:52
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 50%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450499 Aboriginal and Torres Strait Islander health and wellbeing not elsewhere classified @ 50%
SEO Codes: 20 HEALTH > 2002 Evaluation of health and support services > 200299 Evaluation of health and support services not elsewhere classified @ 70%
21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210399 Aboriginal and Torres Strait Islander health not elsewhere classified @ 30%
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