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Question (not being sarcastic): what's the difference between 'science-based medicine' and 'evidence-based medicine'? I did a quick Wikipedia search, but the fo

by austinz 12y ago

Question (not being sarcastic): what's the difference between 'science-based medicine' and 'evidence-based medicine'? I did a quick Wikipedia search, but the former just redirects to the latter.

wanion 12y ago
Science Based Medicine is a movement to improve Evidence Based Medicine with a stronger focus on scientifically rigorous evidence. It's not in opposition to EBM. To quote the SBM blog's about page: "Good science is the best and only way to determine which treatments and products are truly safe and effective. That idea is already formalized in a movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has limitations and problems in practice: it often overemphasizes the value of evidence from clinical trials alone, with some unintended consequences, such as taxpayer dollars spent on “more research” of questionable value. The idea of SBM is not to compete with EBM, but a call to enhance it with a broader view: to answer the question “what works?” we must give more importance to our cumulative scientific knowledge from all relevant disciplines." You can find the original Science Based Medicine announcement on their blog http://www.sciencebasedmedicine.org/hello-world/ http://www.sciencebasedmedicine.org/hello-world/ and there's a decent bit of background on Pain Science https://www.painscience.com/articles/ebm-vs-sbm.php https://www.painscience.com/articles/ebm-vs-sbm.php as well.
- austinz 12y ago
  Thanks! Exactly what I was looking for.
Alex3917 12y ago
EBM involves using science to determine the safety and efficacy of any given treatment. Oftentimes multiple studies are combined using metaanalysis, an approach that has both strengths and weaknesses. SBM, despite the name, believes that using science to study medical treatments is often a waste of money regardless of whether a treatment is very effective or completely ineffective; their claim is that there will always be some studies that say the treatment works and other studies that say the treatment doesn't work, and spending more money will just yield more unreliable data. They therefore believe that the bulk of scientific resources should be dedicated to research reinforces society's prior beliefs, and that research on the efficacy of any given drug should be weighted based on society's prior beliefs. You can read more about this philosophy here: http://www.sciencebasedmedicine.org/hello-world/ http://www.sciencebasedmedicine.org/hello-world/ If it seems somewhat muddled and handwavy as to how exactly prior beliefs and evidence should be weighted, well, this is why I personally think of SBM as the 'white person stamp of approval' approach to medicine. But certainly they have a point that a lot of medical research is complete crap.
- logfromblammo 12y ago
  Not knowing anything about the praxis of SBM, I presume that "prior beliefs and evidence" would be in the nature of noticing that people once used aspen bark tea to treat pain and fever, then determining through a series of experiments the exact molecule or group of molecules that produced the effect. At the end of the experiments, you determine that acetylsalicylic acid, ingested orally, is an effective remedy for pain and fever, with side effects stomach irritation etc. I also presume that there is a more important aspect. If society believes that homeopathy works and that vaccines cause autism, that would be good cause to conduct very rigorous, credible (and above all media-friendly) experiments testing those beliefs. If society believes that eating too many eggs is bad for you, test it. If we believe drinking red wine is good for you, test it. If we believe reptilian aliens are using sodium fluoride in the water supply as an adjuvant for their mind control rays, test it. I presume, without knowing, that this particular aspect of SBM is very much about countering all the junk science hucksters stowing away on the gravy train, just because no one bothers to grab their freeloading asses and throw them off. So when Dr. Selschupplementsondeside (who may or may not be inspired by an actual person) touts a miracle cure on his cable television show, you put that on your list for potential testing and start tracking the hype versus scientific credibility ratio. If too many people start believing without knowing, you need some experimental results. We can't test everything, so focus on testing the unanswered questions. Test the home remedies and traditional cures. Debunk the junk science.
- oldmanjay 12y ago
  Is the racism necessarily part of it? Or do you feel like white people are deserving of any indirect scorn you wish to heap on them?
  - Alex3917 12y ago
    > Is the racism necessarily part of it? Or do you feel like white people are deserving of any indirect scorn you wish to heap on them? I mean a large part of medical research is basically appropriating plant medicine from indigenous cultures and then sending people to prison for using the same medicine in plant form. So yes, racism does play a large part in the medical system.
teddyh 12y ago
I think the real question most people want to know the answer to is: Is one of them a front for homeopathy, anti-vaccinations and/or Scientology, or are they both mostly imperceptibly different degrees of serious research? Downvoters: Please explain. I have no idea about what any of SBM or EBM is, and I hadn’t even heard about any of them before now. This is genuinely what I what to know when I encounter the terms.
- wanion 12y ago
  EBM is meant to be serious science, but there's been a real effort to co-opt it for quackery. SBM is an attempt to inject science back into it. The difference comes down to how they treat evidence. For example, homeopathy states that a remedy becomes stronger the more dilute it becomes - i.e. the lower the dose, the stronger the effect. This defies the dose-response relationship between an active ingredient and its effect. Further, it states that even when no more of the active ingredient remains, it can still have an effect. SBM would say homeopathy isn't worth studying because it has no plausibility based on what we know of medicine and physics. EBM would say let's test it and see what we get. The problem is that if you test the same thing enough times, or measure enough variables, and then discard the ones that don't meet your desired outcome, you can gather "evidence" for basically anything. SBM would say weak evidence for a claim like homeopathy is meaningless, as the claim is extraordinary (it overturns physics), so you need stronger evidence than you might accept for a less exceptional claim. EBM doesn't make that judgment, it treats all evidence as equally valid.
  - heliumcraft 12y ago
    for the record: homeopathy does not do well with EBM either.. (as in quality double blind studies)
    - spydum 12y ago
      sure, but if researchers can cherry pick the data and studies, they just have to avoid those quality double blind studies. all of a sudden, their meta analysis of # studies shows significance!
Paradigma11 12y ago
EBM can only be the first step. The goal has to be a thourough understanding of the domain so that testing a specific case is no longer necessary. This is something that many proponents of EBM do not seem to understand. You do not test basic physical laws, you just look them up.

by austinz 12y ago

Question (not being sarcastic): what's the difference between 'science-based medicine' and 'evidence-based medicine'? I did a quick Wikipedia search, but the former just redirects to the latter.

wanion 12y ago

Science Based Medicine is a movement to improve Evidence Based Medicine with a stronger focus on scientifically rigorous evidence. It's not in opposition to EBM. To quote the SBM blog's about page: "Good science is the best and only way to determine which treatments and products are truly safe and effective. That idea is already formalized in a movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has limitations and problems in practice: it often overemphasizes the value of evidence from clinical trials alone, with some unintended consequences, such as taxpayer dollars spent on “more research” of questionable value. The idea of SBM is not to compete with EBM, but a call to enhance it with a broader view: to answer the question “what works?” we must give more importance to our cumulative scientific knowledge from all relevant disciplines." You can find the original Science Based Medicine announcement on their blog http://www.sciencebasedmedicine.org/hello-world/ http://www.sciencebasedmedicine.org/hello-world/ and there's a decent bit of background on Pain Science https://www.painscience.com/articles/ebm-vs-sbm.php https://www.painscience.com/articles/ebm-vs-sbm.php as well.

austinz 12y ago
Thanks! Exactly what I was looking for.

Alex3917 12y ago

EBM involves using science to determine the safety and efficacy of any given treatment. Oftentimes multiple studies are combined using metaanalysis, an approach that has both strengths and weaknesses. SBM, despite the name, believes that using science to study medical treatments is often a waste of money regardless of whether a treatment is very effective or completely ineffective; their claim is that there will always be some studies that say the treatment works and other studies that say the treatment doesn't work, and spending more money will just yield more unreliable data. They therefore believe that the bulk of scientific resources should be dedicated to research reinforces society's prior beliefs, and that research on the efficacy of any given drug should be weighted based on society's prior beliefs. You can read more about this philosophy here: http://www.sciencebasedmedicine.org/hello-world/ http://www.sciencebasedmedicine.org/hello-world/ If it seems somewhat muddled and handwavy as to how exactly prior beliefs and evidence should be weighted, well, this is why I personally think of SBM as the 'white person stamp of approval' approach to medicine. But certainly they have a point that a lot of medical research is complete crap.

logfromblammo 12y ago
Not knowing anything about the praxis of SBM, I presume that "prior beliefs and evidence" would be in the nature of noticing that people once used aspen bark tea to treat pain and fever, then determining through a series of experiments the exact molecule or group of molecules that produced the effect. At the end of the experiments, you determine that acetylsalicylic acid, ingested orally, is an effective remedy for pain and fever, with side effects stomach irritation etc. I also presume that there is a more important aspect. If society believes that homeopathy works and that vaccines cause autism, that would be good cause to conduct very rigorous, credible (and above all media-friendly) experiments testing those beliefs. If society believes that eating too many eggs is bad for you, test it. If we believe drinking red wine is good for you, test it. If we believe reptilian aliens are using sodium fluoride in the water supply as an adjuvant for their mind control rays, test it. I presume, without knowing, that this particular aspect of SBM is very much about countering all the junk science hucksters stowing away on the gravy train, just because no one bothers to grab their freeloading asses and throw them off. So when Dr. Selschupplementsondeside (who may or may not be inspired by an actual person) touts a miracle cure on his cable television show, you put that on your list for potential testing and start tracking the hype versus scientific credibility ratio. If too many people start believing without knowing, you need some experimental results. We can't test everything, so focus on testing the unanswered questions. Test the home remedies and traditional cures. Debunk the junk science.
oldmanjay 12y ago
Is the racism necessarily part of it? Or do you feel like white people are deserving of any indirect scorn you wish to heap on them?
- Alex3917 12y ago
  > Is the racism necessarily part of it? Or do you feel like white people are deserving of any indirect scorn you wish to heap on them? I mean a large part of medical research is basically appropriating plant medicine from indigenous cultures and then sending people to prison for using the same medicine in plant form. So yes, racism does play a large part in the medical system.

teddyh 12y ago

I think the real question most people want to know the answer to is: Is one of them a front for homeopathy, anti-vaccinations and/or Scientology, or are they both mostly imperceptibly different degrees of serious research? Downvoters: Please explain. I have no idea about what any of SBM or EBM is, and I hadn’t even heard about any of them before now. This is genuinely what I what to know when I encounter the terms.

wanion 12y ago
EBM is meant to be serious science, but there's been a real effort to co-opt it for quackery. SBM is an attempt to inject science back into it. The difference comes down to how they treat evidence. For example, homeopathy states that a remedy becomes stronger the more dilute it becomes - i.e. the lower the dose, the stronger the effect. This defies the dose-response relationship between an active ingredient and its effect. Further, it states that even when no more of the active ingredient remains, it can still have an effect. SBM would say homeopathy isn't worth studying because it has no plausibility based on what we know of medicine and physics. EBM would say let's test it and see what we get. The problem is that if you test the same thing enough times, or measure enough variables, and then discard the ones that don't meet your desired outcome, you can gather "evidence" for basically anything. SBM would say weak evidence for a claim like homeopathy is meaningless, as the claim is extraordinary (it overturns physics), so you need stronger evidence than you might accept for a less exceptional claim. EBM doesn't make that judgment, it treats all evidence as equally valid.
- heliumcraft 12y ago
  for the record: homeopathy does not do well with EBM either.. (as in quality double blind studies)
  - spydum 12y ago
    sure, but if researchers can cherry pick the data and studies, they just have to avoid those quality double blind studies. all of a sudden, their meta analysis of # studies shows significance!

Paradigma11 12y ago

EBM can only be the first step. The goal has to be a thourough understanding of the domain so that testing a specific case is no longer necessary. This is something that many proponents of EBM do not seem to understand. You do not test basic physical laws, you just look them up.