When I was a collection development librarian in a previous life, the university at which I was employed was opening a medical school. I spent many hours talking to the new medical librarian about how to build collections that would support the new college, and since I had never worked with a medical school before I was learning something new every day. Thankfully, the medical librarian was experienced and we formed good connections with the new faculty and administration to be sure that we were building the collections they needed on opening day.
It was at this time that I learned about something called Evidence Based Medicine (EBM)--or medical practice that would be based on the best and most current published clinical evidence. This was to be a foundation of what the new college taught. I learned about resources such as EBSCO’s DynaMed, described thus:
“DynaMed delivers the most current and accurate, evidence-based content for practicing clinicians. Our multidisciplinary team systematically and objectively surveys emergent scientific literature and clinical practice guidelines. Relevant information is captured, appraised, and synthesized rapidly into DynaMed’s clinical content…”
It always seemed reassuring that EBM was based on the latest research. It seemed desirable that physicians would not be working with what they learned in medical school twenty or thirty years before. After all, published medicine based on clinical trials is the solid foundation upon which new research and clinical practice is built, isn’t it? What’s not to like?
Now, I have since learned that there are profound disagreements among medical researchers and practitioners concerning EBM. But my purpose in bringing up EBM relates more to the replication crisis that is currently in the news. As a non-specialist with a humanities education, I have to say that the replication crisis in medical publishing makes me think differently about EBM, as well. If the purpose of EBM is to equip physicians with the latest research so that they can make the best clinical decisions, doesn’t it matter if the latest research can be shown to be pretty uneven, at best? Doesn’t it compromise the decision making of physicians by providing unsupported or misleading information?
Obviously, I don’t say any of this as a participant in medical controversy. It’s more that, as a participant in the world of scholarly communication, the news that raises doubts about the reliability of medical research also gives me pause as a patient whose physician may be using an EBM-based decision tool! After all, if one of the criticisms of EBM is that it renders the clinical experience of the individual physician secondary to the authority of the published literature, perhaps the replication crisis says something in favor of the experience of the individual physician, after all? Or maybe, if medical publishing can be cleaned up, it will make EBM more attractive?
At any rate, I dare not venture onto that specialized ground! All I can say is: medical publishing and medical researchers need to address the shortcomings that are being exposed in this replication crisis--not as an exercise in damage limitation, but with real improvements that allow people to regain confidence in the findings of a very important field of research and practice.
By Matthew Ismail
Featured Image Credits: Chemistry Lab, July 8, 2009 | © Courtesy of canyon289/Flickr.