This is a copy of an email sent to ebmJeddah Yahoogroups on March 6, 2005 in response to an article published in Al Watan Newspaper by Prof. H. Alzahrani downgrading the value of EBM.
Objections to EBM is not new. Clearly, Prof. Al Zahrani is not the first one to raise this point with objections to EBM. However, the new thing is the harsh reply and aggressiveness of labelling all those who practice EBM as “ilmani”. I hope that this labelling will not go further more. This sort of judgemental opinion is the norm in our culture, especially in KAAU where I graduated. You are either with me or against me. I think we should deal with the dispute in a more reasonable friendly way.
I think the main problem is the mis-understanding of EBM and narrwoing it down to “research-based medicine”. I will not repeat what is written in the literature (an example attached as a pdf file). However, I will summarize the article in 4 points. EBM is based on 4 domains: 1. Clinical state and circumstances. 2. Research evidence. 3. Patients preferences. and 4. Clinical expereince of the physician. It is very obvious that the bulk of Prof. Al Zahrani’s article is focued on “research evidence” ignoring the remaining 3 domains of the current model of EBM.
As Prof. Al Zahrani clearly indicated that Muslim Scholars initiated the principles of Modern Medicine. However, he did not mention that that excellence was based on applying the proper principles of scientific research methodology and experiments. It seems that the word “research” was intentionally ignored. Thus, Muslim Scholars are indeed the first to lay the foundations of EBM. For the years that followed those golden years, we all went into dormant state and were improting the evidence. I hope we are wakening up now to re-apply the principles of scientific methodology. So I hope we are not “ilmanis” and not “extremists” on the other hand.
EBM is difficult to practice not because it is a rocket science but because it is time consuming. It entails being up to date with the current medical literature. To practice EBM, you have to be flexible in agreeing to change your practice based on the current evidence. We all now that behavior modification is one of the most difficult challenge for humans. Basically, to practice EBM means that you will have less time for the private sector. This explains why EBM does not appeal to some.
If Prof. Alzahrani’s point was we should do our own research rather than utilizing (importing) the available evidence. I totally agree with him. RCTs and other levels of evidence done elsewhere cannot be always extrapolated and generalized to different ethnic groups and population. Furthermore, from Islamic point of view, we have to utilize economic analyses (cost-effectiveness, cost-utility and cost-benefit analyses) to decide what is the best cost-effective treatment option for a given clinical problem to avoid wasting unnecessary money. In order to make an informed decision, we have to conduct our own economic analyses.
Finally, I have few questions for Prof. Al Zahrani: “How should we practice Medicine?”. Should we ignore textbooks? (At the end of the day, textbooks are based on research evidence and clinical experience of the authors). Should we ignore patients preferences?. Should we ignore the clinical state of the problem and use a cook book Medicine for every single patient?. If we cannot ignore these questions, then we should practice EBM!