Reprinted with Permission
As defined in 1996 by one of its founders, David Sackett, evidence-based medicine is “the integration of individual clinical expertise with external evidence from systematic studies.” Edward Whitney, MD, MSPH, notes that while the concept had been around for years, evidence-based medicine did not emerge as a formally recognized approach until the early 1990s when opinion leaders began making the case for it. Their position was strengthened when several widely accepted treatments, which were based on general medical and biological principles, were scientifically disproven by random trial studies.
Whitney gives the following example to illustrate: Before 1990, medical experts theorized that premature ventricular contractions, if left untreated, could increase one’s risk for sudden cardiac death, which accounted for thousands of fatalities per year in the United States. To address this concern, many practitioners supported the use of a particular drug therapy that was shown to be effective in suppressing the contractions.
It seemed to be a reasonable approach—so much so that some experts argued it would be unethical to conduct a random trial to test the theory, since such a study would assign some patients to receive placebos rather than the drug therapy. Despite these protests, a randomized trial was conducted in 1990—and it found that, far from helping reduce the risk of sudden cardiac death, the drug therapy actually increased it. The research made national news—and became a watershed event in gaining acceptance for evidence-based medicine.
Related articles:
Guidelines Help Emphasize Value of Psychological Evaluations in Workers’ Compensation Arena.
For more information…
• Official Disability Guidelines (ODG)
See www.disabilitydurations.com
• State of Colorado Division of Workers’ Compensation Practice Guidelines
See www.coworkforce.com/DWC/Ruleshtm/rulescontents.asp
• Occupational Medicine Practice Guidelines published by American College of Occupational and Environmental Medicine (ACOEM)
See www.acoem.org/whatsnew/pracguide.asp
• An evaluation tool designed by Kathryn Mueller, MD, MPH, to assess how providers are using ACOEM guidelines
Can be used as a medical record that providers fill out to gather quality improvement feedback; or by case managers to do chart reviews.
• A report on evaluation of users’ responses to ACOEM guidelines
Mueller KL, Harris JS, Low P, Koziol-McLain J, Peplowski B. Acceptance and self-reported use of national occupational practice guidelines. Journal of Occupational and Environmental Medicine, 1999, 42:362–369.
Kathryn Mueller, MD, MPH, is an associate professor at the University of Colorado Health Sciences Center, an attending physician at National Jewish Medical and Research Center, and residency director for the University of Colorado occupational medicine residency program. She is also medical director of the Colorado Division of Workers’ Compensation and secretary/treasurer of the American College of Occupational and Environmental Medicine (ACOEM). Dr. Mueller received her MD from the University of Nebraska Medical School and her Masters in Public Health from the Medical College of Wisconsin. She is board-certified in Occupational Medicine.
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