4 ms·

evidence-based What’s the difference between something being scientific and something being evidence-based?

SamoyedFurFluff 3y ago
Evidence-based is a subset of scientific, imo. A study of cells in a Petri dish is science but I wouldn’t recommend a drug to a person from such a study.
raincom 3y ago
As I wrote in another reply, evidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (as instrumentalism is one of philosophies of sciences): pick a treatment that works for a large number of people, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action (MOA).
- haldujai 3y ago
  I would add that EBM took over because science-based medicine (at least the historical definition, how it's used now is more of a hybrid) didn't work out too well. Often the mechanism thought to be understood is incorrect or more complicated and the outcomes don't correlate well with what's expected, sometimes resulting in significant harm. Fundamentally, the mechanism of why a medical intervention works isn't that important if you're thoroughly evaluating outcome measures and controlling confounders.
haldujai 3y ago
A simple example is (using the traditional understanding of these differences): Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE. Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin therapy is recommended in [specifically defined population] to reduce MACE.
- coding123 3y ago
  > Cholesterol levels are associated with major adverse cardiovascular events > statins lower cholesterol levels and therefore You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.
  - haldujai 3y ago
    > You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons. I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one. Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today. Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer: The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention). In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured). In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).
pella 3y ago
evidence-based: the "PARACHUTE trial" ( real + satirical ) "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial" https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094 "Conclusions Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention." Please read the context: https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-without-parachutes-and-lived-to-tell-the-tale/ https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-w...

Evidence-based is a subset of scientific, imo. A study of cells in a Petri dish is science but I wouldn’t recommend a drug to a person from such a study.

raincom 3y ago

As I wrote in another reply, evidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (as instrumentalism is one of philosophies of sciences): pick a treatment that works for a large number of people, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action (MOA).

haldujai 3y ago
I would add that EBM took over because science-based medicine (at least the historical definition, how it's used now is more of a hybrid) didn't work out too well. Often the mechanism thought to be understood is incorrect or more complicated and the outcomes don't correlate well with what's expected, sometimes resulting in significant harm. Fundamentally, the mechanism of why a medical intervention works isn't that important if you're thoroughly evaluating outcome measures and controlling confounders.

haldujai 3y ago

A simple example is (using the traditional understanding of these differences): Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE. Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin therapy is recommended in [specifically defined population] to reduce MACE.

coding123 3y ago
> Cholesterol levels are associated with major adverse cardiovascular events > statins lower cholesterol levels and therefore You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.
- haldujai 3y ago
  > You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons. I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one. Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today. Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer: The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention). In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured). In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).

pella 3y ago

evidence-based: the "PARACHUTE trial" ( real + satirical ) "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial" https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094 "Conclusions Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention." Please read the context: https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-without-parachutes-and-lived-to-tell-the-tale/ https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-w...