Evidence-Based Medicine
Personalized Medicine
Why true evidence-based medicine is more than randomized studies: It combines scientific evidence with personal expertise and individual experience.
Evidence-Based Medicine
Why true evidence-based medicine is more than randomized studies: It combines scientific evidence with personal expertise and individual experience.
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During the pandemic, we were terrorized by unprecedented scientific fundamentalism. Science seemed more like a kind of religion. "You must believe in this scientific finding, otherwise you're a denier!"
Difficult. Science produces knowledge. And of course, this knowledge should be taken into account in everyday life. But many misunderstand what science can do – and what it cannot. Because unlike religion, there is simply no universally valid creed, no all-encompassing wisdom, especially when it comes to new scientific findings.
This natural uncertainty factor exists – it creates space for the individual. More on that in a moment. This very inherent property is also a weakness of science. True deniers then simply claim whatever they want.
Speaking of individuals. For you and your own unique experience of the world, entirely different rules apply. Unfortunately, this too is widely misunderstood today – especially by those who are most scientifically dogmatic and proudly proclaim themselves "Evidence-based" or "Science-based."
Here, typically only so-called gold-standard studies count. For example, randomized controlled trials ("RCTs") or meta-analyses – that is, large evaluations of precisely such studies.
Only results and findings derived from such studies are accepted. Yet strictly speaking, this is anything but scientific or even "evidence-based." The founder of Evidence-based Medicine (EBM), David Sackett, recognized these tendencies back in 1996 and formulated in his essay what Evidence-based Medicine actually means:
"Evidence-based medicine is not restricted to randomized trials and meta-analyses. It is about finding the best external evidence with which we can answer our clinical questions."
For the person who is treating – whether that's a doctor or even you yourself! – it is especially true that science should "inform individual clinical expertise, but never replace it; and it is this expertise that determines whether the external evidence is relevant to the individual patient at all, and if so, how it should be integrated into a clinical decision."
There is no single science, no single set of findings. You yourself, but above all the person treating you – who is essentially practicing science on you – must, based on their personal expertise and personal experience, combined with any and all forms of scientific knowledge, try to present you with a fitting solution to your problem.
Sackett writes:
"Sometimes the evidence we need comes from the basic sciences like genetics or immunology."
The more individual the question becomes, the more abstract it becomes. Because above the level of the individual – which one can practically only describe more precisely through personal experience or, for example, genome analysis – is already the level of the group.
All the knowledge that science presents to us is at best results obtained from specific groups of people, groups that have already been selected based on certain preconditions.
If, for instance, the question were about recovery after a single exercise session, one could say with certainty at best that ... experienced athletes who have trained for at least 2–3 years (condition 1) and are under 30 years old (condition 2) and eat an omnivorous diet (condition 3) should recover within 24–72 hours.
A randomized controlled trial might have discovered this within a specific time frame under certain conditions. It's certainly good to know. But what can you derive from this for yourself?
Under your own personal conditions, you might be fully recovered after just 16 hours or not until after 80 hours. The range is enormous. And that is precisely the weakness of science when it comes to the individual. And that is precisely why the experience of the person who should assess and treat you matters so much. This is where the wheat separates from the chaff among good doctors, practitioners, bloggers, and so on.
And that is exactly edubily's mission. Not only to show you this tension, but to provide you with solutions from every level of science, so that you can make the best decisions for yourself. Evidence-based, truly.
