There are many problems in EBM, but also many solutions. Some ideas have been tried before; some will be completely new.
EBMLive encourages working groups to identify, take forward and implement solutions for better evidence and healthcare.
The EBM Manifesto facilitates the generation of jobs and potential solutions to serious flaws in the creation, dissemination, and implementation of medical research.
There are Four Doors through which you can support the principles in the EBM Manifesto, participate in EBMLive and achieve better healthcare.
We welcome your IDEAs for better evidence:
Identify and fix problems with research evidence
Develop research evidence
Enhance real-world practice
Add capacity globally
Why we need IDEAs and an EBM manifesto?
Patients are being let down by serious flaws in the creation, dissemination, and implementation of medical research. Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated only piecemeal. 1 As the volume of clinical research activity has grown, 2 the quality of evidence has often worsened, 3 which has compromised medicine’s ability to provide affordable, effective, high-value care for patients.”
Why can’t we trust the evidence?
Beyond disquiet, evidence suggests that most published research is more likely to be false than true. 4 Serious systematic bias, 5 error and wastage 6 are also well documented in medicine, and significantly affect the implementation and uptake of evidence into practice. This lack of uptake is compounded by poorly managed commercial and academic vested interests; 7 bias in the research agenda (often due to the failure to take account of the patient perspective in research questions and outcomes); 8 9 poorly designed research trials that suffer from a lack of transparency and independent scrutiny, fails to follow protocols 15 or trials that are stopped too early; 16 10 poor quality dissemination of research too often permits ghost authorship,11 publication 12 and reporting bias (including the under-reporting of harms) 13 14 and publishes results that are over-interpreted or misused, 17 or sometimes have uncorrected errors 4 or undetected fraud 18 19
Bad evidence feeds into poor decisions. And a host of allied organisations and industries have sprung up around evidence to address this problem. Yet, these too are beset with problems such as untrustworthy guideline production, 20 regulatory failings,19 and delays in the withdrawal of harmful drugs.21 Collectively these failings contribute to escalating costs of treatment,22 medical excess (including the related concepts of medicalisation, overdiagnosis, and overtreatment) 23 and avoidable harm. 21
Clinicians and patients increasingly find it difficult to identify and integrate trusted evidence into informed healthcare due to the unmanageable volume of evidence,2 the lack of research answers that matter to patients and the lack of evidence to support shared decision making, 25 3
Steps for developing more trustworthy evidence
The manifesto steps required to develop trustworthy evidence have been refined through a series of stakeholder engagement activities including seminars, round-tables, online consultations and through direct feedback with stakeholders. As a result of these discussions, a set of nine steps has been identified
1) Expand the role of patients, health professionals and policy makers in research
2) Increase the systematic use of existing evidence
3) Make research evidence relevant, replicable and accessible to end users.
4) Reduce questionable research practices, bias, and conflicts of interests
5) Ensure drug and device regulation is robust, transparent and independent
6) Produce better usable clinical guidelines.
7) Support innovation, quality improvement, and safety through the better use of real world data.
8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices.
9) Encourage the next generation of leaders in evidence-based medicine.