Evidence-Based Medicine: Perspectives and Roles of the Health Library

Abstract

The Evidence-Based Medicine movement, as launched at the beginning of this decade, has proved to be a most controversial and extensively debated approach to the provision of medical care, in terms of the volume of literature published about it within such a short period of time, the range of interpretations placed on it, and the opinions expressed. The criticisms and attacks are sometimes personal, on the supposedly patronizing, ivory tower attitude of the proponents as self-appointed “guardians of the truth”, or on the policy-makers and managers who support them, who allegedly think only in financial terms and disregard patient values and preferences or the expertise of individual physicians. Sometimes the concept itself is attacked, either on the grounds that medicine has always been evidence-based and it is presumptuous to present EBM as a new discipline; or on the philosophical or logical grounds that in medicine the term “evidence” is incorrect and misplaced;¹ or on methodological grounds, on the basis that the results of Randomized Controlled Trials (RCTs), meta-analyses and systematic reviews are irrelevant when applied to individual patients. It is claimed that “infostat” medicine i.e. based on “information and statistics” (or “practising medicine by numbers”) abrogates clinical responsibility, because it ignores what happens to the individual patient once the guidelines and rules have been applied.