As with any concept, there are disadvantages as well as advantages of applying evidence based medicine to modern healthcare; despite the integration of evidence based medicine in the curriculum for university medical studies courses, as a relatively new practice the number of healthcare professionals not familiar with such a routine is still fairly high. Furthermore, many of those who practised long before the implementation of evidence based medicine feel it undermines their clinical expertise and the value of their experience to a degree. This point is also relevant when considering individual approach to carrying out medical procedures and treating patients. Surgeons, for example, often have a preferred methodology for carrying out operations or a particular instrument they prefer to use which may go against guidelines established as a result of evidence presented by relevant trials; this raises the question of whether they are then obliged to change a habit of numerous years to fit in with modern, unfamiliar guidelines.
Short term cost is an obvious limitation but can be justified to some extent when considering the long term cost-effectiveness of using evidence based medicine. The decision related to which research programmes to fund raises ethical as well as economic issues but it is obviously not possible to fund research into every known illness.
A Lack of Evidence
Critics of the evidence based medicine system have stated that most commonly a lack of funding for research means there is a lack of sufficient evidence for treatments associated with many different illnesses, particularly those that are relatively uncommon. If no money is committed to researching certain illnesses then it is possible that no progress will ever be made concerning the treatment of that particular illness, despite advances in technology and scientific research possibilities. In addition to this, research suggests that not all data is made available for all to see, with negative trials often not published; this infers a degree of selectivity and bias.
The Personal Touch
Whilst the evidence supporting the benefits of evidence based medicine is abundant in terms of determining effective treatments, this concept does not account for issues such as how an individual patient feels from one day to the next; even if a drug is proven scientifically to be effective it will still affect each individual in a different way and therefore some patients may not follow the predicted course of recovery. In addition to this, the use of evidence based medicine often comes under fire for suggesting a generalised, collective approach to patient care rather than being focused on one individual at a time. Also, the relevance of trials to the patient must be addressed; for example if a study has concluded that a drug is effective in the treatment of 10-20 year old Asian males, is it right to assume that that drug will be as effective in a group of 60-70 year old White females?
Lack of Skills
Critics have expressed concern that those healthcare professionals who have not previously been specifically trained to interpret the data they receive do not have the necessary skills to do so and are therefore struggling to act in accordance with new guidelines. In addition to this, it is anticipated that there is little time allocated for learning these skills due to the busy and stressful nature of the healthcare profession.