Infinite thanks for this video. As a massage therapist, my education in reading high tier research is minimal. Learning how to interpret EBM will be a critical component towards my professional enrichment. Thank you for your videos.
Thank you Dr Eric for summarizing the difficulty and fear in a lot of junior doctors like myself in applying EBM in my day to day practice. In particular, your point about not blindly following algorithms but instead integrating patient values, communications and clinical judgements reminds me of the intricacy in serving in the medical field.
Outstanding, as usual. A comprehensive introduction to such a fundamental subject worldwide and one that has become specially so, here in Brazil! Looking forward to the next instalments of this series, Dr. Eric.
I was taught "TIPCO" as the acronym (versus PICO) The "T" stands for "Time" (e.g. Treatment for 5-weeks, or 10-year survival, etc). - we were taught that these are the variables (in addition to a patient's informed preference) that allow you to decide if a study applies to your individual patient. Thanks for another great lecture!
I don't know if a "full" course on EBM will be coming, but a small number of additional videos on the topic will be coming soon. Unfortunately, biostats as a separate topic is not in the foreseeable future - too many other competing requests.
The term "evidence-based" is now a dated term and is based on the medical model of health. The term "evidence-informed" is preferred b/c it not only depends on published evidence, but professional opinions, best practice guidelines (e.g., for COVID-19, Ebola) that often are fluid and evolving in nature, community partners and stakeholders (e.g., Indigenous elders). Cheers, Dr. Wally J. Bartfay
Sir! Thank you for you great intro, Due to internet restrictions in China, I would like to inquire whether we may have your permission to repost your video on the Chinese video platform Bilibili, so that more Chinese viewers can gain knowledge about evidence-based medicine. Of course, we will acknowledge the source of the original video in the description and provide a link to your RUclips channel . Thanks !
I'm so sorry, I'm just seeing your question now! 98% of my videos are free on the RUclips channel here. I don't have any kind of subscription service. The 2% that's not here are things which are not quite finished, or which I want to vet with a colleague first, but which will be uploaded soon.
Thank you very much ,very nice explanation ,but l have question Is evidence based medicine depends on others studies? Is patient expectation is most important than experience and evidence?
It's intended for a general audience and not just healthcare professionals per se, but I found Ending Medical Reversal by Cifu and Prasad to be a great book touching on many issues (particularly problems) in the design and interpretation of clinical research.
@@StrongMed Thanks, I will check it out! I have really enjoyed John Ioannidis' talks and papers on the matter too. However, I find most discussions on EBM to be primarily focused on the evidence side of things and less on the 'integration with clinical experience and patient values'. Talks, books, papers on that would be very welcome. Thanks for a great channel, I have been watching your videos for a couple of years now!
Society is based on progress such as: Evidence-based constructions buildings - machinesThis exists because every part of the construction is known down to the detail, composition, size and objective. This allows a scientific certificate of the degree of quality to be delivered. Evidence-based medicine of the human body with 100% living cells that can grow, multiply and die, but nobody knows exactly how that happens. Consequently, delivering a scientific certificate with the grade of quality does not exist, because:- one does not know the composition of 1 living cell, let alone that medicine will determine how to repair the cells.- the totality of the number of cells is unknown.- one does not know the functions of the cells that make the body function optimally.- one does not know the totality of functions in the body.- the name, proteins, vitamins, ... and their composition are a vision, but nobody can determine the exact composition of the atoms and physical properties exactly. The same for neurons, genes ... are a name for something that is not known exactly. Conclusion: therefore there is no evidence-based medicine if the basic elements cannot be precisely described. The result: the human body is not a well-known medium for internal processing without causing damage. But the problem is much worse:- the scientists, doctors and politicians have laws approved whereby dead cells = chemicals come into contact with a medium of 100% living cells: the human body. The result: dead cells (chemicals) do not have a medicinal effect, but poison and a number of side effects have arisen. The law encourages the use of poison, this is not possible because a law cannot be used to harm people. The same reasoning applies to animals and nature that also consist of 100% living cells. The scientists are responsible for their absurd conclusions and actions.
Patient, lawyer's and hospital management always needs evidenced based treatment otherwise some day may be a bad day. Expert opinion has no say in court of law.
Unfortunately, in the US, expert opinion actually legally supersedes evidence in malpractice lawsuits. (Yes, I know that sounds crazy) 66.199.228.237/mofo/pdf/evidence_based.pdf
Obviously few doctors would outwardly claim they are not basing their treatment on evidence, but before the advent of EBM ~1990, that was how the vast majority of doctors practiced - they practiced based on what they had been taught in medical school and residency (with a little sprinkling of their own anecdotal experiences); and what they had been taught was based on what their instructors had been taught (again, with a little sprinkling of anecdotal experiences). In fact, many doctors still practice this way to variable extent. Thus, medicine has been slow to adopt new ideas, and frequently uses treatments which are not helpful, and in some cases even harmful. By coining the term EBM, the first advocates of this approach were deliberately emphasizing a core principle of medicine practice: treatment should be based on clinical trials (i.e. the "evidence" of EBM doesn't refer to any evidence at all, but rather predominantly randomized controlled trials). Unfortunately, there are some major shortcoming of this philosophy. First, some questions simply aren't amenable to practical clinical trials. But more importantly, the pendulum swung too far in the other direction, whereby if there was a clinical trial that showed X, people considered X to be truth, irrespective of how implausible X was to begin with, or whether or not the clinical trial had major flaws. This was certainly not the intention of the creators of the EBM concept, but it's nevertheless what happened. This has been particularly problematic with believers of "alternative medicine", who latch on to any clinical trial evidence - no matter how shaky or implausible - as proof of their treatment de jour. In response to this, some now advocate for either a switch from EBM to "science-based medicine", or at least, considering SBM alongside EBM. SBM places more emphasis on scientific first principles. So for example, imagine a clinical question of whether acupuncture can treat infertility. A dogmatic EBM devotee might say "We won't know until we do a double blinded randomized controlled clinical trial", whereas a dogmatic SBM devotee might say "There's no plausible scientific mechanism by which acupuncture could have that effect, so therefore a clinical trial is not needed to say 'no', it does not work". So I might argue that "science-based medicine" is an even worse name, for the same reason: what doctor would say they aren't practicing based on science? ;)
definition of EBM 1:35 ; 5 A's of EBM 2:33 ; observational study, trails and reviews 2:54 to 4:36 ; trail 4:57 ; hierarchy of evidence 6:59 ; clinical guideline 8:41 ; limitations of EBM 9:42 ; publication bias and conflict of interests 10:44
Infinite thanks for this video. As a massage therapist, my education in reading high tier research is minimal. Learning how to interpret EBM will be a critical component towards my professional enrichment.
Thank you for your videos.
Thank you Dr Eric for summarizing the difficulty and fear in a lot of junior doctors like myself in applying EBM in my day to day practice. In particular, your point about not blindly following algorithms but instead integrating patient values, communications and clinical judgements reminds me of the intricacy in serving in the medical field.
Outstanding, as usual. A comprehensive introduction to such a fundamental subject worldwide and one that has become specially so, here in Brazil! Looking forward to the next instalments of this series, Dr. Eric.
That is very true! Great thanks from Brazil.
as usual Dr Eric elucidate our long standing confusions and medical knowledge gap.
tks a lot DOC for your commitment
I was taught "TIPCO" as the acronym (versus PICO)
The "T" stands for "Time" (e.g. Treatment for 5-weeks, or 10-year survival, etc).
- we were taught that these are the variables (in addition to a patient's informed preference) that allow you to decide if a study applies to your individual patient.
Thanks for another great lecture!
Doctor Eric... You're just soooo great.
Please create a full course on EBM and biostatistics :)
I don't know if a "full" course on EBM will be coming, but a small number of additional videos on the topic will be coming soon. Unfortunately, biostats as a separate topic is not in the foreseeable future - too many other competing requests.
Thank you Dr Eric, clear simple explanation about EBM.
Great presentation on EBM,,lots of regards from chennai India
Please continue this series. It is so helpful!
Thank you for making this video Dr. !
So grateful I stumbled onto this, thank you sir yo talk is very clear and on point
This video is so excellent and clear. Thank you.
two words: crystal Clear. thank you for this vid!
The term "evidence-based" is now a dated term and is based on the medical model of health. The term "evidence-informed" is preferred b/c it not only depends on published evidence, but professional opinions, best practice guidelines (e.g., for COVID-19, Ebola) that often are fluid and evolving in nature, community partners and stakeholders (e.g., Indigenous elders). Cheers, Dr. Wally J. Bartfay
God bless you sir, and all people you love.
Pls define placebo... really we know how exactly placebo works?
Sir please make videos on how to approach a case in general such that there is no biasing due to the speciality of a doctor .
A change in clinical guidelines forced me to leave my doctor of 20 years! Would he have treated me so badly if he had not been forced?
great teaching, thanks
Sir! Thank you for you great intro, Due to internet restrictions in China, I would like to inquire whether we may have your permission to repost your video on the Chinese video platform Bilibili, so that more Chinese viewers can gain knowledge about evidence-based medicine.
Of course, we will acknowledge the source of the original video in the description and provide a link to your RUclips channel . Thanks !
Thank you for asking, but as a blanket rule, I do not allow my work to be posted on other platforms by third parties.
@@StrongMed Thank you for your reply!
@@StrongMed So Could we translate this video, send you the Chinese subtitles and please add them to your video?
superb description.....
very informative. thanks alot
i love EDM. I'm going to ultra this year.
🤮🤮
Yea i love EDM especially house, future bass, and randomised controlled trials
Sir,
How can I get all of your videos?
Does you tube contains all? or you have many more?
Can we purchase videos from All subjects?
Thank You sir.
I'm so sorry, I'm just seeing your question now! 98% of my videos are free on the RUclips channel here. I don't have any kind of subscription service. The 2% that's not here are things which are not quite finished, or which I want to vet with a colleague first, but which will be uploaded soon.
Do you suggest any books to introduce EBM?
Great intro
Thank you very much ,very nice explanation ,but l have question
Is evidence based medicine depends on others studies?
Is patient expectation is most important than experience and evidence?
Can you post videos on 'How to do a meta-analysis and bibliometric analysis'?
Sorry, just seeing this question now. Hoping to tackle meta-analysis some time in the next year, but can't make any estimate of when that might be.
I would like to use this video in my EMS education for paramedics. Non commercial., Attribution will be provided. Thanks.
Not a problem at all! Hope your students will find it useful!
Thank you!
very nice infomation
Thanks, that's helpful
wow.. great
Well said that is pinpoint accurate
awsm
Any recommendations for books on the topic?
It's intended for a general audience and not just healthcare professionals per se, but I found Ending Medical Reversal by Cifu and Prasad to be a great book touching on many issues (particularly problems) in the design and interpretation of clinical research.
@@StrongMed Thanks, I will check it out! I have really enjoyed John Ioannidis' talks and papers on the matter too. However, I find most discussions on EBM to be primarily focused on the evidence side of things and less on the 'integration with clinical experience and patient values'. Talks, books, papers on that would be very welcome.
Thanks for a great channel, I have been watching your videos for a couple of years now!
I also love to dance to EDM
CTS meaning please
Society is based on progress such as:
Evidence-based constructions buildings - machinesThis exists because every part of the construction is known down to the detail, composition, size and objective.
This allows a scientific certificate of the degree of quality to be delivered.
Evidence-based medicine of the human body with 100% living cells that can grow, multiply and die, but nobody knows exactly how that happens.
Consequently, delivering a scientific certificate with the grade of quality does not exist, because:- one does not know the composition of 1 living cell, let alone that medicine will determine how to repair the cells.- the totality of the number of cells is unknown.- one does not know the functions of the cells that make the body function optimally.- one does not know the totality of functions in the body.- the name, proteins, vitamins, ... and their composition are a vision, but nobody can determine the exact composition of the atoms and physical properties exactly.
The same for neurons, genes ... are a name for something that is not known exactly.
Conclusion: therefore there is no evidence-based medicine if the basic elements cannot be precisely described. The result: the human body is not a well-known medium for internal processing without causing damage.
But the problem is much worse:- the scientists, doctors and politicians have laws approved whereby dead cells = chemicals come into contact with a medium of 100% living cells: the human body.
The result: dead cells (chemicals) do not have a medicinal effect, but poison and a number of side effects have arisen.
The law encourages the use of poison, this is not possible because a law cannot be used to harm people. The same reasoning applies to animals and nature that also consist of 100% living cells. The scientists are responsible for their absurd conclusions and actions.
Patient, lawyer's and hospital management always needs evidenced based treatment otherwise some day may be a bad day. Expert opinion has no say in court of law.
Unfortunately, in the US, expert opinion actually legally supersedes evidence in malpractice lawsuits. (Yes, I know that sounds crazy) 66.199.228.237/mofo/pdf/evidence_based.pdf
Thank you ..
+Strong Medicine
Wow! That's worth knowing--and not a single mention (so far) in my medical education.
Worst name ever for a concept. What doctor would say they are not basing their treatment on evidence?
Obviously few doctors would outwardly claim they are not basing their treatment on evidence, but before the advent of EBM ~1990, that was how the vast majority of doctors practiced - they practiced based on what they had been taught in medical school and residency (with a little sprinkling of their own anecdotal experiences); and what they had been taught was based on what their instructors had been taught (again, with a little sprinkling of anecdotal experiences). In fact, many doctors still practice this way to variable extent. Thus, medicine has been slow to adopt new ideas, and frequently uses treatments which are not helpful, and in some cases even harmful. By coining the term EBM, the first advocates of this approach were deliberately emphasizing a core principle of medicine practice: treatment should be based on clinical trials (i.e. the "evidence" of EBM doesn't refer to any evidence at all, but rather predominantly randomized controlled trials). Unfortunately, there are some major shortcoming of this philosophy. First, some questions simply aren't amenable to practical clinical trials. But more importantly, the pendulum swung too far in the other direction, whereby if there was a clinical trial that showed X, people considered X to be truth, irrespective of how implausible X was to begin with, or whether or not the clinical trial had major flaws. This was certainly not the intention of the creators of the EBM concept, but it's nevertheless what happened. This has been particularly problematic with believers of "alternative medicine", who latch on to any clinical trial evidence - no matter how shaky or implausible - as proof of their treatment de jour.
In response to this, some now advocate for either a switch from EBM to "science-based medicine", or at least, considering SBM alongside EBM. SBM places more emphasis on scientific first principles. So for example, imagine a clinical question of whether acupuncture can treat infertility. A dogmatic EBM devotee might say "We won't know until we do a double blinded randomized controlled clinical trial", whereas a dogmatic SBM devotee might say "There's no plausible scientific mechanism by which acupuncture could have that effect, so therefore a clinical trial is not needed to say 'no', it does not work".
So I might argue that "science-based medicine" is an even worse name, for the same reason: what doctor would say they aren't practicing based on science? ;)