The current situation of the shared human experience currently is one for the history books. A modern pandemic in a truly globalized society has caused innumerable and widespread effects. In the collective effort to combat the pandemic, a huge slew of research and data has become available in an unheard-of period of time. With all this data as well as the best intentions, the world’s top minds have rushed to put forth clinical treatments and best practices to address the current pandemic. While some treatment’s may have shown some inherent benefit, this urgency has caused missteps with respect to evidence-based medicine bringing into question the efficacy of said treatments and practices. The question becomes, how should the development and implementation of therapy be approached to ensure a rapid, efficient, and scientifically proven solution given a rapidly evolving and complex situation such as the current pandemic?
This is something that is currently open to interpretation and brings with it some contention. In a paper published to the international Emergency Medicine Journal, the authors make the argument that it is now more than ever that we must “double down” and prescribe ourselves to the practices of evidence-based medicine! They go on to explain that while there is a direct mortal threat from the pandemic, rushing to provide unproven treatments to patients, especially in a widespread public health approach, does not come without tradeoffs. Even when the perceived risks are minor, the tradeoffs such as lost time or even unforeseen circumstances counterbalance the potential benefit. Hence, “doubling down” and challenging the scientist to be better and more collaborative to provide a sound proven treatment paradigm is necessary. (Carley, Horner, Body, & Mackway-Jones, 2020) Alternatively, an editorial posted to the PLOS Medicine journal provides a subtly different perspective.
The PLOS Medicine article presents an argument that the current framework for evidence based medicine is much too rigid to keep up with such a rapidly developing situation such as the current pandemic. The article further goes to argue that the cost of waiting for a fully vetted solution i.e. the traditional evidence-based medicine approach, is too high. That a change to the current approach to developing treatment strategies is necessary. Further arguing that these real-world problems are often complex and dynamic requiring a multifaceted approach that reflects the modern era. While the editorial does not suggest casting aside evidence-based medicine, it does suggest that evolving towards a willingness to accept practice-based evidence in conjunction with evidence-based medicine is what is necessary. Essentially fusing the two practices together to promote an agile solution. That treatment from say “trial and error” like studies (practice-based evidence) based on the best knowledge available can be used to help advance understanding and provide insight into the evidence based medicine approach and possibly provide a rapid solution. (Greenhalgh, 2020)
While both articles present a valid argument and provide solid points, in all actuality it is most likely that a hybrid of both of these approaches is what will ultimately prove to be the best practice. Favoring too heavily on the regimented evidence-based medicine approach would cause a delay in treatment, while moving too rapidly without fully appreciating the risks may cause unintended harm to patients. All things considered, maybe the middle of the current pandemic is not be the best time to fully upend the scientific community’s approach to problem solving? Maybe after this pandemic it is time that we consider looking deeply into how therapies are vetted and implemented with respect for the modern age if not simply to challenge ourselves to be better for the next pandemic?
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