Tuesday, January 13, 2009

Evidence-Based Medicine (EBM) vs Web 2.0

A few days ago I read an excellent blog post by librarian, Laika (Jacqueline) entitled: The Web 2.0-EBM Medicine split. Introduction into a short series. In the post, Laika talks about how she sees a conflict between EBM and Web 2.0, and that got me thinking about my experiences of finding evidence-based information on the Internet.

Testing the divide between EBM and Web 2.0
This week I have been researching information for a series of posts I have been writing about birth units: what they are, effect of environment on birth, why women want to birth in birth units, design aspects and birth outcomes. As a midwife I have a sense that homely birth units are more likely to support normal birth compared to hospitals, and decrease the rates of medical interventions. So I decided to see if the research evidence supported my beliefs.

Searching for evidence-based information
The reality was that it was very difficult to find evidence-based information that I could have free access to. I used Google, Pubmed and Google Scholar which pointed me to a number of studies about birth, environment, midwifery care and place of birth. But when it came to accessing the full articles, I found many were unavailable unless I subscribed to a database or journal.

Free resources
One of the most useful free resources was Google Books which previewed several books I was able to use in my research. The problem was that the preview only allowed me to see certain pages, and you could bet your bottom dollar that the pages I wanted to see were unavailable. The other problem was that Google Books does not appear to preview newly published books (or at least, not the ones I wanted to read).

The other really useful free resource was the Cochrane Database which publishes reviews of evidence-based information and is highly regarded in medical and health spheres. However, it is still difficult to access the original studies.

Using Web 2.0 to 'research'
As an adjunct to the scientific, published research I decided to use some Web 2.0 tools and ways of doing things to find out information. Using Twitter and this blog, I put out a call for people's views on birth units. The replies were instant, and interestingly they replicated the published research findings.

But because I did not use a recognised research pathway, and my blog is not considered to be a credible, peer-reviewed publication, the responses I have gained and the continuing conversations I am having will not be considered as viable evidence in many quarters.

Barriers to EBM
The reality is that evidence-based information is difficult to source from primary sources. The average person of the street who does not have access to specialist libraries or databases with free full-text articles. Indeed, neither do health practitioners unless they are somehow connected to an educational institution. The cost of subscriptions to databases and journals is prohibitive to the individual practitioner and health consumer.

Authoriative knowledge
But does that not suit us as health professionals? We all know knowledge is power, so if we are the only ones who access to evidence-based information, it gives us power over our patients/clients. And that's quite a convenient place to be in if we want patients to do what we want them to do.

Web 2.0 challenges the authoritative knowledge of medicine and health professionals. Web 2.0 challenges us to be open about what we are doing and thinking; to share and collaborate with each other and patients; to make information freely available so that patients can use it to take an active part in decision-making. But do health professionals really want that?

EBM 2.0?
As a health professional I welcome evidence-based practice. In midwifery, research has seen the end of many routine practices that have at the very least been unpleasant (pubic shave and enemas) and at the worst, darn right harmful (episiotomy). It is vital that my practice is based on the latest up to date information so that the care I provide pregnant women is the best, based on what we currently know.

However, I also feel that it is vital that we integrate the principles of Web 2.0 into our practice so that evidence-based information is freely available to all, health practitioners and consumers. That we work together to share and collaborate, and find alternative ways of communicating and disseminating information to the traditional journals that are locked up, and only available to those who can afford to pay to read them.

How do you think we can use online tools such as blogs and wikis to disseminate evidence based information? What are the problems with utilising information in practice that is not published in conventional medical, peer-reviewed journals? How do we overcome fears about credibility?

As a health consumer, where do you go for health information? Would you trust what a doctor, nurse or midwife said on a blog?

Do you really feel there is conflict between Web 2.0 and EBM? If so, what can we do about it?

Jordan, B. (1997). Authoriative knowledge and its construction. In R. Davis-Floyd & C. Sargent (Eds.), Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives (pp 55-79). University of California Press: Princeton.

Image: 'Soudeh under Serum' Hamed Saber


Buckeyebrit said...

Big, really important questions! For me all thinsg web 2.0 offer the most amazing opportunity to tap into the clinical reasoning of a huge number of health professionals. Also for lots of cross fertilisations (pardon the reproductive pun) between professions (I am an OT) of ideas and thought processes. The honesty, information sharing and self reflection needed (IMO) to make a great blog can be challenging to many. We must develop ways to overcome this and weave the "formal" evidence into the powerful professional reasoning of experience and anecdote.

Sarah Stewart said...

Couldn't agree more. Love the concept of 'weaving' formal evidence into our professional reasoning etc. Thank you.

Anne Marie said...

Hi Sarah,
Think you have seen my reply already:)

Helen said...

Hi Sarah
Excellent thoughts. I agree that people outside the educational institutions have limited access to databases and journals to find refereed articles. And knowledge is power - authoratative knowledge as well as experiential knowledge. I think it depends a bit on the context - if I want some basic health advice I will definatly google my symptoms and try to work out what is wrong with me and how to fix it. It is very thought provoking - what is the future of authoritative knowledge as EBM increases? Good questions.

Sarah Stewart said...

@ Anne Mare - great post - loving this conversation.

@Helen I see no reason why EBM & Web 2.0 cannot compliment each other. It's the attitudes of a lot of academics that stand as barriers ie the 'preciousness' about research.

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Jeffrey Keefer said...

Sarah, you are raising some really interesting questions here, and they have me thinking about their implications in 2 major ways.

Firstly, I am co-teaching a doctoral nursing class at Pace University in the Summer, Teaching and Learning in Advanced Practice Nursing. Evidence-based practice is a pillar of the program, and Web 2.0 certainly changes things, or at least our perception of things (I wonder if these are really the same or different?). I will send a few colleagues to see this for their thoughts.

Additionally, I am beginning my own doctoral studies next month toward a PhD in E-Research and Technology Enhanced Learning. The issues of knowledge and authority and power relationships have floated around higher education and "academic" knowledge for some time, and Web 2.0 really throws that into the air.

I am very interesting in this topic, and am wondering who, if anybody, is exploring it more fully. Want to consider a research project in this area???

Sarah Stewart said...

I'd be really keen, but I wouldn;t be able to think about it for a couple of months-got to get my eMentoring project under way.

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