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.
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.
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?
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