Dr KK Aggarwal
The practice of medicine is an art based on science. Today, evidence-based medicine has become the norm in clinical practice. Application of evidence-based medicine in day to day practice means relating individual clinical signs, individual clinical experience with the best scientific evidences obtained by the clinical research.
Scientific system of medicine evaluates any health practice, product, based on the scientific evidence available. Scientific system of medicine takes into consideration all of the scientific evidence in their entirety. It also takes into consideration prior scientific plausibility or prior likelihood, whether that treatment is a valid treatment and is effective, when evaluating health or scientific claims or assertions, which evidence-based medicine does not.
Any pathy can have treatment at any level of evidence.
· Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.
· Level II: Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).
· Level III: Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).
· Level IV: Evidence from well-designed case-control or cohort studies.
· Level V: Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).
· Level VI: Evidence from a single descriptive or qualitative study.
· Level VII: Evidence from the opinion of authorities and/or reports of expert committees.
Randomized controlled trials (RCTs) are regarded as Level 1 evidence and have been ranked highest. Observational studies, generally regarded as Level II or level III evidence, have been shown to be comparable to RCTs. Therefore, observational studies are also important as evidence for a said practice or treatment or product.
The word ‘observation’ is defined in the English dictionary as “an act of noting and recording any event”. In terms of science, this can be likened to recording any data generated out of an experiment. Any observation therefore is potential evidence (JAMA. 2000;284(10):1290-1296).
There should be only one system of medicine, the scientific system of medicine. And, all pathies must validate their effectiveness through scientific evidence.
Disclaimer: The views expressed in this write up are entirely my own.