Evidence-based medicine breaks paradigms

Abstract

Mrs. Editor.

Evidence-based medicine (EBM) refers to the integration of the best evidence dence available with clinical experience and patient values¹. Your introduction to clinical practice allows evaluating correctness clinical studies (methods and statistical results) to use the therapies pias that produce greater security with a affordable cost-benefit, considering the ethical aspects of the interventions.

Its application transcends the clinical field, helping to generate a thought critical. Its principles and methods can be extrapolated to health management under the term «evidence-based management», what the information analysis requires to apply it in the public sphere and evaluate your results for modifications and improve its impact on the population. East process allows prioritizing resources, always limited to safe and effective strategies to cover always unlimited needs.

During the COVID-19 pandemic, the need and deficiency of incorporation of EBM in various areas of health has been more evident as a result of the quantity and quality of information generated during this crisis, which has had repercussions important information about individual patients, patient groups (implementation of care protocols) and on the societies dades (orientation of economic resources for the implementation of those protocols).

 Many of the promising interventions care systems and protocols were based on reports of questionable quality, being the hydroxychloroquine one of the most emblematic², that later The RECOVERY study demonstrated the absence of any benefits that could be attributed to it, as with aspirin, azitromycin, colchicine, lopinavir, ritonavir and reciently with ivermectin³.

I agree with Dr. Sandoval⁴, to the state that it is necessary to keep informed men to attend to health problems of people and that the pandemic of COVID-19 has shown that systems scientific communication do not satisfy the needs of science and society. Without However, this learning is actually one of the sides of a coin. The first expensive is the need for gold: information. The second is: «not all that glitters is gold» (must analyze the evidence) and the latter is the that has marked the pandemic the most.

Health paradigms have evolved from a magical-religious conceptioneven to a scientific system. Prior to the implementation of the strategies ofMBE, medical practice was practiced under the cloak of the so-called empirical sciences⁵, and the medical interventions that were carried out during this time were transmitted from teacher to student in the form of dogma, without being questioned; guided by common sense. These interventions became customs and finally laws. Once they have acquired this category, they it took several centuries before the first concept of EBM emerged whose main notioncipal can be summed up with the phrase: «Nullius in verba » (in the mouth of no one); that is, not influenced by any person (regardless of their renown, position social or labor) and that decisions were based on a scientific basis. Are premises certainly went against a paradigm with years of foundation.

 Currently, certain remnants of the magical paradigm can be observed-religious; the one who conceived the disease as supernatural facts that were dueaccept, because that's how they were. In a similar way passed on medical knowledge and now it happens with the interpretation of scientific information. To ensure that users of medical publications, professionals and managershealth, achieve differentiation of information scientific of the one that has the most evidence, is the current challenge of EBM, and the one that it has been most apparent during the pandemic. Leave behind the remnants of the paradigm magical-religious, requiring attention and the involvement of all key stakeholders: researchers, teachers, doctors, medical associations, student associations, etc. Although progress has already been made, anticipated cultural resistance is expected in the words of Martínez-Lovo: «always it was easier to explain natural phenomena under concepts contributed by sense common, without ever stopping to reflect on the why of such events from a scientific perspective »⁶. To address the problems of the two sides of the coin (need for information and form of information analysis) and achieve the paradigm shift, significant contributions have been made: the magazine Alert opens an important channel of scientific communication in Spanish, open access, which makes information accessible by lowering language and economic barriers. It represents a stimulus for national actors interested in producing scientifically they can access the scientific world. On the other hand, resources such as «The ABC of critical reading»⁷, allow to know elementary notions for the analysis of scientific information. Similarly, they are remarkable contributions from students of thehealth area in spaces like Students for Best Evidence, a site that recentlyhas been translated into spanish and portuguese, allowing to reduce the language barrier and that opens spaces for production student scientist for free, while instructing on MBE related concepts and publication analysis scientific, showing that all key players can add their grain of sand. The current global emergency has shown the most striking evidence of how dynamic medicine is and that valuation adequate scientific information depends on accentuating the paradigm shift with implementation of the MBE. Professionals who dare to embark on that deep sea will better adapt to the changes that are already taking place and, consequently, will have greater chances of success. It is necessary to remember that success in medical science is summed up in human lives. These considerations about EBM and its benefits for patients mean that its application is also be an ethical issue for professionals in health. Advance the paradigm transition it is not an easy path and you have the opportunity to be entrepreneurs in our field. I dream of seeing that cultural change applying at all levels.