Research Summary: Evidence based medicine: a movement in crisis? by Matt Holland

The first part “Evidence based medicine: a movement in crisis?” is a critique of the Evidence Based Medicine [EBM] movement. In summary the criticism are these:

“The evidence based “quality mark” has been misappropriated by vested interests

The volume of evidence, especially clinical guidelines, has become unmanageable

Statistically significant benefits may be marginal in clinical practice

Inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred

Evidence based guidelines often map poorly to complex multimorbidity” (Greenhalgh et al. 2014)

No need to repeat the elaborations of these points here. Take a moment to read the original essay now, if you haven’t already.

The counter to the crisis of EBM put forward by the authors are actions to bring about Real EBM:

“Patients must demand better evidence, better presented, better explained, and applied in a more personalised way

Clinical training must go beyond searching and critical appraisal to hone expert judgment and shared decision making skills

Producers of evidence summaries, clinical guidelines, and decision support tools must take account of who will use them, for what purposes, and under what constraints

Publishers must demand that studies meet usability standards as well as methodological ones

Policy makers must resist the instrumental generation and use of “evidence” by vested interests

Independent funders must increasingly shape the production, synthesis, and dissemination of high quality clinical and public health evidence

The research agenda must become broader and more interdisciplinary, embracing the experience of illness, the psychology of evidence interpretation, the negotiation and sharing of evidence by clinicians and patients, and how to prevent harm from overdiagnosis” (Greenhalgh et al. 2014)

Again reading the original article for a more detailed explanation of these points is recommended. These arguments have wide ranging implications for research, the publication and presentation of research evidence, the way in which clinicians are trained and how they use evidence to inform practice. Most of these issues are explored in the Rapid Responses to the paper also published online. Worth noting as well is that at the time of this post the full text has been viewed 36 thousand times, see the Metric tab for the most up to date figures.

Does that mean Evidence Based Librarianship is in crisis too?

“Evidenced based” is described as a brand. In adopting the methods and terminology of the “Evidenced Based” franchise, Evidenced Based Librarianship inherits some of the challenges that Greenhalgh et al. (2014) outline. Perhaps we should also consider some of the proposed solutions. In the spirit of “rapid response” here are some thoughts on what that might look like.

  • Evidence based librarianship in the broadest sense means adopting practices with a proven value, well founded in empirical research. Good things might include using the methodology of the Systematic Review to synthesise research on the positive value of health care libraries. Challenges could be an over systematised approach that diminishes the role of open discussion to arrive at creative solutions to problems. A strong evidence base requires a diversity of methodological approaches, including qualitative methods, to be complete.
  • The users of the service, clinicians or patients, should be the point of a health care library service. They are the place where thinking about health care librarianship should start. The difference between how are we going to make you want the service we feel (or are told) you want and what services do you actually want. History tells us (me) that no amount of quantitative research will find this out. Sometimes you just need to talk and filter the conversation though the lens of experience and professional judgement.
  • Resist the tendency to manage services rather than deliver them. Guidelines should be good, policies should be published, strategies should be farsighted, boxes should be ticked and fads and fashions should be vigorously challenged. However, service to users should always be first.
  • How do we deliver outputs to users in a form that they can use them? Information Skills Training aspires to high ideals of life-long learning and autonomous users of databases and other information tools. At some level though, information literacy sessions are mitigating the effects of poorly designed, difficult to use and complex products. Users, contrary characters that they are, stray from the path to the easy to use and easy to access. How do we combine the characteristics of ease of access and quality information? We all struggle with the same problem; perhaps we should just talk about it a bit more.
  • As health care librarians we are both actors and collaborators in the evidenced based project. We should add our voice in support of what is good and speak out against what is bad. The Greenhalgh et al. (2014) article would seem to provide a sound base line for knowing the difference.

Reference: Greenhalgh, T.,  Howick,J. & Maskrey,N., 2014. Evidence based medicine: a movement in crisis? BMJ 2014;348:g3725. Available from:  http://dx.doi.org/10.1136/bmj.g3725 [Accessed 09 July 2014].

Matt Holland, Librarian, NWAS NHS Trust
BA, DMS, Dip Lib, MA, MCLIP
Mobile: 07747456736,
E-Mail: Matt.Holland@nwas.nhs.uk,
Website: http://www.networks.nhs.uk/nhs-networks/nwas-library-and-information-service

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