Evidence Based

Medicine
Michael Y Kopinsky
 – An approach to medical practice intended to
optimize decision-making by emphasizing the use
of evidence from well-designed and well-
conducted research.
– Although all medicine based on science has some
degree of empirical support, EBM goes further,
What is classifying evidence by its epistemologic strength
and requiring that only the strongest types can
EBM? yield strong recommendations.

https://en.wikipedia.org/wiki/Evidence-based_medicine
 Why should medicine be based
on evidence?

Why? Why would medicine be based

on anything but evidence?
Thought – What if we did evidence based software
Experiment: development?
 – “Clinical judgment” or “the art of medicine”
In Contrast – Experience-based Medicine
To… – Personalized medicine
– Science-based medicine
Types of Evidence
 – Randomly assign people to receive either a new
diabetes drug or an existing diabetes drug and see
who does better
Poll: – Try a new surgical technique on a dozen patients,
write a journal article about successes and pitfalls
– Compare diabetes rates across large cities in the US,
Which of examining impact of income, race, healthy lifestyle,
regional diet on rate of diabetes
these are
– Roll out a texting program to sepsis survivors at one
valid hospital but not another, and compare readmission
rates at the two hospitals
experiments?
– Do a literature review of all studies on stimulant
medication for adolescents with ADHD, and report on
overall results
Levels of
Evidence
Searching
PubMed
 “Hey guys, I did something cool”

“Whoa, this crazy thing happened”

Case Reports
“Whoops, let’s not do that again”

“Huh. That’s interesting.”

Levels of
Evidence
Experimental
Designs
Non-
Experimental
Designs
Levels of
Evidence
Systematic
Review
Systematic
Review
Review of
Reviews
 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC30
0808/
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300
808/citedby/
Tangent:
Parachutes! – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC62
98200/
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58
78948/
Levels of
Evidence
Clinical
Guidelines
AFP Guideline:
Management of Blood
Glucose with Noninsulin
Therapies in Type 2 Diabetes
Clinical
Guidelines
AFP Guideline:
Arthropod Bites
 – Recommendation 1: ACP recommends against
screening for chronic kidney disease in
asymptomatic adults without risk factors for
chronic kidney disease. (Grade: weak
recommendation, low-quality evidence)
– Recommendation 3: ACP recommends that
Strength of clinicians select pharmacologic therapy that
includes either an angiotensin-converting enzyme
evidence inhibitor (moderate-quality evidence) or an
vs. angiotensin II–receptor blocker (high-quality
strength of evidence) in patients with hypertension and stage 1
recommendation to 3 chronic kidney disease. (Grade: strong
recommendation)

– Michael’s Recommendation: Michael

recommends that you don’t walk into the street in
front of a moving car (no evidence, strong
recommendation)
guidelines.gov
 – Randomly assign people to
receive either a new RCT
diabetes drug or an existing
diabetes drug
– Try a new surgical technique
on a dozen patients, write a Case Report
journal article about
Poll: successes and pitfalls
– Compare diabetes rates
across large cities in the US,Case Control
examining impact of
Which of income, race, healthy
lifestyle, regional diet on
rate of diabetes
these are valid – Roll out a texting program
Cohort

experiments? to patients at one hospital,

and compare readmission
rates at the two hospitals
– Do a literature review of all
studies on stimulant Review/
medication for adolescentsMeta-analysis
with ADHD, and report on
overall results
 – Questions?

– mkopinsky@gmail.com
Thank you! – twitter.com/mkopinsky
– www.waytohealth.org