Improving nutrition science begins with asking better questions
4
Citation
14
Reference
10
Related Paper
Citation Trend
Abstract:
A priority of nutrition science is to identify dietary determinants of health and disease to inform effective public health policies, guidelines, and clinical interventions. Yet, conflicting findings in synthesizing evidence from randomized trials and observational studies have contributed to confusion and uncertainty. Often, heterogeneity can be explained by the fact that seemingly similar bodies of evidence are asking very different questions. Improving the alignment within and between research domains begins with investigators clearly defining their diet and disease questions; however, nutritional exposures are complex and often require a greater degree of specificity. First, dietary data are compositional, meaning a change in a food may imply a compensatory change of other foods. Second, dietary data are multidimensional; that is, the primary components (ie, foods) comprise subcomponents (eg, nutrients), and subcomponents can be present in multiple primary components. Third, because diet is a lifelong exposure, the composition of a study population's background diet has implications for the interpretation of the exposure and the transportability of effect estimates. Collectively clarifying these key aspects of inherently complex dietary exposures when conducting research will facilitate appropriate evidence synthesis, improve certainty of evidence, and improve the ability of these efforts to inform policy and decision-making.Keywords:
Scientific evidence
Confusion
Certainty
Evidence-Based Medicine
Empirical evidence
Evidence-Based Medicine is a relatively new movement that seeks to put clinical medicine on a firmer scientific footing. I take it as uncontroversial that medical practice should be based on best evidence—the interesting questions concern the details. This paper tries to move towards a coherent and unified account of best evidence in medicine, by exploring in particular the EBM position on RCTs (randomized controlled trials).
Evidence-Based Medicine
Scientific evidence
Best evidence
Cite
Citations (282)
Currently, evidence-based medicine is subject of a controversial discussion. This review is focused on the different types of evidence in clinical medicine and elaborates the history and context of evidence-based medicine. Evidence-based medicine insists that the theoretical plausibility of a therapeutical concept alone does not substitute for the empirical proof of its efficacy. Evidence-based medicine emphasizes the necessity to complement the individual physician's clinical experience with valid external evidence. This evidence has to be obtained by laborious systematic reviews rather than the traditional fragmentary study of the literature. The Cochrane Collaboration stands for this concept. The application of evidence-based medicine links the individual patient's problems with external evidence by asking defined answerable questions and supplies criteria for the critical evaluation of the evidence found. Evidence-based medicine, however, is not devoid of problems and contradictions. Above all, it has to be subjected to its own criteria and has to prove its efficacy.
Evidence-Based Medicine
Relevance
Empirical evidence
Cite
Citations (6)
Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops.
Expert opinion
Empirical evidence
Scientific evidence
Cite
Citations (13)
Abstract As scientist-practitioners, we want our clinical efforts to be supported by scientific evidence. Indeed, science can provide the most compelling evidence that our treatments are beneficial to our clients rather than ineffective or harmful for them. Not only does scientific evidence meet our own values and standards for the credibility of psychotherapeutic treatment, it provides accountability to our clients and to third-party payers, who increasingly want evidence that what they pay for is effective. Thus, the demand for scientific evidence is high, and many treatments and providers seek the mantle of scientific respectability.
Scientific evidence
Empirical evidence
Cite
Citations (8)
Scientific evidence
Empirical evidence
Scientific literature
Affect
Empirical Research
Cite
Citations (3)
Scientific evidence
Assertion
Evidence-Based Medicine
Cite
Citations (5)
Undoubtedly, the ultimate intention of EBM is to provide a theoretical background on which evidence-based practice (EBP) is founded. However, does reliance on EBM dictums always leads to an equally satisfying EBP? Are they two sides of the very same coin? Are EBM-drawn conclusions too hard-and-fast to defy any argument, reasoning, challenge or questioning? Such idealism is still, unfortunately, out of reach. It is prudent to ask ourselves one important question: is evidence-based medicine really evidence-based? If so, how could we explain the discrepancies and inconsistencies existent between EBM and EBP? How did such discrepancies arise?
Evidence-Based Medicine
Argument (complex analysis)
Empirical evidence
Evidence-Based Practice
Real world evidence
Best evidence
Cite
Citations (3)
If the term ‘ evidence‐based medicine ’ conveys more than is conveyed by the word medicine, then there must be a way to distinguish between evidence‐based medicine and non‐evidence‐based medicine. In particular, there must be a logically acceptable way to classify medical decisions as justified or unjustified by scientific evidence. In this essay I examine the nature of medical theories, the nature of the evidence that is produced by empirical tests of medical theories, and the relation of medical decisions to both. I conclude that attempts to classify medical decisions as justified or unjustified by scientific evidence have no foundation in logic and that the term ‘evidence‐based medicine’ is logically indistinguishable from the term ‘medicine’. The use of the term ‘evidence‐based medicine’ calls for a new type of authoritarianism in medical practice.
Evidence-Based Medicine
Scientific evidence
Foundation (evidence)
Empirical evidence
Cite
Citations (93)
Abstract Evidence is defined by its ability to establish or support conclusions. Evidence‐based medicine (EBM) equates evidence with scientific evidence and views factors such as clinical expertise as important in moving from evidence to action. In contrast, we suggest that EBM should acknowledge multiple dimensions of evidence including scientific evidence, theoretic evidence, practical evidence, expert evidence, judicial evidence and ethics‐based evidence. What EBM loses by not acknowledging these dimensions as evidence is the ability, among other things, to make and defend judgements based on understandings that complement science and are no less important than those science can offer. We argue for a new definition of EBM that, without forced accommodation or unacceptable compromise, acknowledges dimensions of evidence produced within and outside science.
Evidence-Based Medicine
Scientific evidence
Compromise
Empirical evidence
Rules of evidence
Evidence-Based Practice
Complement
Best evidence
Evidence-based management
Cite
Citations (82)
Evidence-based medicine emphasizes that any medical decision must be based on the best available scientific evidence, and any health decision-maker or clinical physician must take all his or her own professional skills and experience, the state- of- the- art medical techniques and the patient's needs and desires into consideration before a scientific and rational medical decision can be made. This paper aims to comprehensively introduce the concept and essence of evidence- based medicine, the steps of clinical practice and the use of Cochrane cooperation network. The relationship among the evidence- based medicine, clinical epidemiology and a systematic review is described, and the application of evidence- based medicine in the interventional therapy and the current problems in clinical practice are briefly discussed.
Scientific evidence
Evidence-Based Medicine
Clinical Decision Making
Clinical Practice
Medical literature
Medical practice
Cite
Citations (0)