The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice: Part One

2013 ◽  
Vol 15 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Clinical Judgment ◽  
Evidence Based Medicine ◽  
Process Model ◽  
Best Practice ◽  
Political Process ◽  
Community Treatment ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Based Medicine

The present article outlines the major limitations of evidence-based medicine (EBM) and through a close review demonstrates that the three component EBM process model is a pseudoscientific tool. Its “objective” component is the collection, systematic analysis, and listing of “effective” treatments applying a research hierarchy from most rigorous (systematic reviews of randomized controlled trials [RCTs]) to least rigorous (expert opinion). Its two subjective components are the clinical judgment of helping professionals about which “evidence-based” treatment to select and the specific and unique relevant personal preferences of the potential recipients regarding treatment. This procedural mishmash provides no more rigor in choosing “best practice” than has been provided by good clinical practitioners in the past because both turn out to be subjective and authority based. The article also discusses EBM’s further methodological dilution in the National Institute of Mental Health (NIMH) endorsed Evidence-Based Mental Health Practice (EBP) movement. In EBP, the allegedly rigorous EBM protocol is altered. Instead of systematic expert protocol-driven EBM reviews of RCTs, NIMH sanctioned expert consensus panels decide “evidence-based practices.” This further problematizes the development of best practices in mental health by converting it to a political process. The article concludes with some observations on these issues. In a second article (part two) forthcoming, assertive community treatment (ACT) is examined as an example of an EBP that fails as a scientifically effective treatment despite its EBP certification and general popularity among practitioners.

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice (Part Two): Assertive Community Treatment Assertively Reviewed

2013 ◽  
Vol 15 (2) ◽  
pp. 73-86 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Assertive Community Treatment ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Community Treatment ◽  
Evidence Based ◽  
Health Delivery ◽  
Based Medicine ◽  
Over 40 Years

This article is the second of two published in Ethical Psychology and Psychiatry; the first appeared in Volume 15, Number 1. The first article argued the very serious limitations of evidence-based medicine (EBM) and its very popular mental health offshoot evidence-based practice (EBP; Gomory, 2013). This article is meant to be a consolidation and update of a 1999 analysis of Assertive Community Treatment (ACT), the best “validated” mental health EBP according the National Institute of Mental Health (NIMH) and academic researchers. This analysis reconfirms the failure of ACT as a treatment modality and a platform for successfully reducing hospitalization; its touted consistent effect except when ACT can apply administrative coercion to keep its clients out of the hospital or quickly discharge them. When ACT fails to have such administrative coercive control, it does no better than other community mental health delivery systems. The use of ACT coercion begun over 40 years ago, the article further argues, set the table for conventionalizing psychiatric coercion as evidence-based best practice.

scholarly journals Involuntary treatment in the community: role of community treatment orders

2010 ◽  
Vol 34 (10) ◽  
pp. 441-446 ◽  
Author(s):  
Sarah Woolley
Keyword(s):  
Mental Health ◽  
Evidence Based Medicine ◽  
Community Treatment ◽  
Evidence Based ◽  
Involuntary Treatment ◽  
Community Treatment Orders ◽  
Literature Reviews ◽  
The Common ◽  
Based Medicine

SummaryAlthough community treatment orders (CTOs) have been used internationally since the 1980s, they were only introduced into England and Wales in 2007 by amendments to the 1983 Mental Health Act. Aimed to replace the common use of extended Section 17 leave to enforce community treatment, CTOs are believed to offer patients more protection owing to stringent criteria for their use. Literature reviews, however, do not demonstrate any evidence favouring the use of CTOs and in this age of evidence-based medicine it is questionable whether psychiatrists will change from a familiar practice to an unproven one.

scholarly journals Psychiatry in the future

2004 ◽  
Vol 28 (8) ◽  
pp. 277-278
Author(s):  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Cochrane Collaboration ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Policy Makers ◽  
The Future ◽  
The Cochrane Collaboration ◽  
Based Medicine

In an era of evidence-based medicine, policy-makers and researchers are preoccupied by the task of ensuring that advances in research are implemented in routine clinical practice. This preoccupation has spawned a small but growing research industry of its own, with the development of resources such as the Cochrane Collaboration database and journals such as Evidence-Based Mental Health. In this paper, I adopt a philosophically quite unfashionable methodology – introspection – to address the question: how has research affected my practice?

Evidence-based Medicine in Mental Health: Towards Better and Fairer Treatment?

2005 ◽  
pp. 65-75
Author(s):  
Andreas Reis ◽  
Christian Lenk ◽  
Cristiane Reis-Streussnig ◽  
Nikola Biller-Andorno
Keyword(s):  
Mental Health ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

Cowboys and Pirates in Mental Health Care: A Musical Autoethnography

2020 ◽  
pp. 153270862097065
Author(s):  
David Carless
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Evidence Based Medicine ◽  
Spoken Word ◽  
Evidence Based ◽  
Health Care Professions ◽  
Personal Consequences ◽  
Or Organization ◽  
Based Medicine

A cowboy can be defined as “an unscrupulous tradesman” and a pirate can be “a person or organization broadcasting without official authorisation.” Looking through a subversive lens, I see both cowboys and pirates operating within the mental health care professions. Cowboys can be validated, authorized, rewarded, and empowered through the machinery of evidence-based medicine. Pirates may be criticized, restricted, marginalized, or dismissed by the same machinery. Through a layered performance of song and spoken word, I explore some of the personal consequences of all this for those living—and suffering—within differing paradigms of health care.

scholarly journals Awareness and the use of evidence-based medicine resources among physicians

2019 ◽  
Vol 6 (10) ◽  
pp. 4612-4614
Author(s):  
Amjad Alhelo ◽  
Bashar Samara
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Cochrane Library ◽  
Evidence Based ◽  
Cross Sectional ◽  
Evidenced Based ◽  
The Cochrane Library ◽  
Based Medicine

Aim: to evaluate awareness and the use of evidence-based medicine resources among physicians in Jordan.  Method: A cross-sectional study by internet was performed among 517 doctors who were responsive from a total of 717 doctors, a total of 72.1% response rate. Doctors from all specialties were contacted from a Facebook group called doctors café in Jordan. A questionnaire was given to each one of them to measure their awareness and use of Evidence based database.   Result: From 517 physicians 377 they are using evidenced based resources frequently, and 91 using resources but not frequently and 49 not using evidence-based resources. The resource that was mostly used by the doctors was PubMed, followed by other resources such as Up to date, National Guideline Clearinghouse, Medscape, BMJ best practice, e-books and other online journals for published papers. The Cochrane Library was surprisingly not so familiar amongst physicians. Conclusion: There is good awareness about EBM among physicians in Jordan, and that benefits health care in Jordan.

Best practice pharmacologic treatment of schizophrenia: Applying principles of evidence-based medicine

2005 ◽  
Vol 3 (2) ◽  
pp. 53-60 ◽  
Author(s):  
Rajiv Tandon ◽  
Naakesh A. Dewan ◽  
Robert J. Constantine ◽  
Jerry Wells
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Evidence Based ◽  
Pharmacologic Treatment ◽  
Based Medicine
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