VBS is a definition proposed in 1992 3 by DL Sackett and collaborators in a manifesto article to indicate a new paradigm for the practice of medicine. The article presents what according to the authors are the basic characteristics of the previous paradigm and those of the new paradigm proposed by them and defined VBS. Click here for more information about pharmaceutical empathy based selling
“Old” paradigm
Non-systematic observations of individual clinical experience are a valid basis for establishing prognosis, the value of diagnostic tests and the efficacy of treatments.
- The study and understanding of the mechanisms of diseases and their pathophysiology are sufficient guidance for medical practice.
- Comprehensive traditional medical training combined with common sense is sufficient to allow the physician to evaluate new diagnostic tests and new treatments.
- Competence in a particular pathology and clinical experience are a sufficient basis for building sound guidelines.
According to the authors’ comment, this paradigm strongly values traditional scientific authority and seeks the answer to the problems posed by clinical practice, especially in direct contact with local experts or in the reading of writings by international experts (in articles or treatises).
New paradigm
It is certain that experience and the development of clinical intuition are necessary components for developing clinical competence (particularly for diagnosis). However, an appropriate methodology is needed to extract from experience the ability to establish a prognosis or the accuracy of diagnostic tests and the effectiveness of treatments.
- Knowledge of the basic mechanisms of diseases and their pathophysiology is necessary but not sufficient for medical practice and can – if isolated – lead to errors in judgment on the accuracy of diagnostic tests and on the effectiveness of treatments.
- Knowledge and understanding of certain rules that allow estimating the validity of the information reported in the literature or provided by experts are necessary to correctly interpret the scientific literature on the aetiology of diseases, prognosis, diagnostic tests and treatment strategies.
Again according to the Authors, this new paradigm reduces the physician’s dependence on the authority of experts, and tends to develop his autonomous judgment capacity, providing him with adequate cognitive tools to improve the quality of observations and the evaluation of scientific literature.
Conclusion
In the years following 1992, the principles of VBS underwent a process of maturation, and an explosive expansion. In a recent letter to Lancet 4, a graph shows that articles mentioning the term “Evidence-based Medicine” reported in Embase went from less than 10 in 1992 to 450 in the first two months of 1997. This article provides a brief summary of the concepts currently contained in the definition of VBS and a personal point of view on the role it can have in clinical practice.
