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Explanatory models are needed to integrate RCT and observational data with the patient's unique biology
1BMJ Evidence Centre, BMJ Group, London WC1H 9JR, UK.
Journal of the Royal Society of Medicine
|January 26, 2012
Summary
Evidence-based medicine (EBM) should integrate disease models to connect evidence with patient biology. Including pathophysiology as evidence enhances clinical decision-making and application of research findings.
Area of Science:
- Medical Research Methodology
- Clinical Decision Making
- Pathophysiology
Background:
- Current evidence-based medicine (EBM) frameworks often lack integration with patient-specific biology.
- The exclusion of pathophysiological models limits the objective application of clinical evidence.
- Historical evolution of EBM has unintentionally sidelined the role of disease mechanisms.
Observation:
- Historical evolution of EBM shows an unintentional subordination of pathophysiology.
- Essential hypertension serves as a case study highlighting the value of disease models and diverse evidence sources.
Findings:
- Integrating pathophysiological models into EBM provides an objective evidence base for extrapolating clinical trial data.
- Pathophysiology itself constitutes valuable evidence, regardless of definition.
Implications:
- Clinicians can utilize a pathophysiological rationale to bridge the gap between general evidence and individual patient biology.
- Incorporating disease models enhances the practical application of EBM, particularly in its fourth stage (application).
- This revised EBM approach supports more personalized and effective patient care.
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