Saturday, March 15, 2008

Evidence-Based Medicine

Last Post Review

Last time (actually, a long time ago) I related a few points of what I consider a strong Health Care Marketing professional. The market has changed; or, even better, it has evolved and thus requires a different kind of professional. As Health Care develops into a more result-oriented business, the more we’ll see the demand for a new type of strategic and commercial approach.

Finally, I received a few feedbacks describing this blog as interesting and fun. Although fun is not my focus here, as a former colleague used to say: “It is better be fun and correct than no fun at all and completely accurate”.

Thank you all for your feedback. Feel free to use this blog, as well as my personal e-mail (click the “Send me an e-mail” link located at the side column).

Evidence-Based Medicine

I’ve seen many colleagues afraid of the EBM concept, “what is this thing?” and “how does it impact my business?”. Well, let’s try to analyze the concept and how to translate it into Evidence-Based Marketing. After all, Marketing is something we can control, while Medicine is not.

But before I start my text, I just want to reemphasize the fact that this blog is focused on the business aspects and implications of Health Care. Therefore, I’ll approach EBM as a Marketing professional and not as a researcher. For more information, I recommend you ask your local Medical Board to understand their perceptions around the theme.

The concept

EBM is, first of all, a methodology created to answer a medical question. This question may represent a problem (i.e. how to reduce the complications associated with a certain surgery) or not (i.e. to determine the best approach to treat a certain condition in a specific type of patient).

The concept was created to bundle three main aspects: 1) Clinical Evidence, 2) Medical Expertise; 3) Value for the Patient. In other words, with EBM we are not only trusting a physician’s individual decision nor saying that everything published is the true.

Clinical Evidence

The main sources of clinical evidences are studies that, once finished, are usually modeled into articles and then made available in renowned publications and databases such as JAMA, Cochrane and BMJ. However the problem is that the vast majority of articles have methodological flaws, placing serious questions around the conclusions and results. The implication: never, NEVER trust an article just because it is published!

How to assess the accuracy and value of an article? How to identify clinical evidence from biased or erroneous statements? Well, first we need to understand that nowadays the part that describes how the study was developed (methods, methodology etc) is much more important than the results part. To illustrate this better, according to a famous Clinical Publication it is estimated that thousands of articles are published every day globally, but just around 10% of them have no basic methodological mistakes. By all means, I’m not saying articles are useless; on the contrary, we need to filter the ones we can apply.

Another step is to classify the article according to its Level of Evidence. Basically, the more sources generate data and the less the researcher intervenes on the results, the better the study. Classifications such as “double-blinded”, “multi-centered” and “randomized” signal strength of a study. But again, it doesn’t mean it is 100% good, we need to first apply a methodological filter
(above paragraph) and then classify it according to its level of evidence, such as the one below.

Medical Expertise

Physicians, Nurses and other Medical professionals have studied for several years and are constantly updating their knowledge in the field. An approach that ignores the academic and professional expertise of these medical professionals cannot be considered a serious method. On the flipside, those days when the doctor’s opinion should be respected and never questioned are gone.

The idea is simple: Health Care is strongly based on technology, and since technical advancements are happening everyday, we cannot apply judgments from 5 years ago into current situations. Or should we use large cassette walkman radios when there are MP3 players available? The problem is when certain professionals feel themselves as more important than the comments they make.

Careful if your KOLs are too much confident to change ideas or to even consider other options. Chances are, you are getting an ego statement rather than a medical opinion.

Also, theory without practice turns into nothing. Ideally, medical professionals apply their existing knowledge to evaluate new evidence and make their decisions. But there is still one last pillar, and the most important one.

Value for the Patients

OK, we have theory (Clinical Evidence) and practice (Medical Expertise), but why are we making a decision? What do we want to accomplish?

This is, by far, the most important aspect of Evidence Based-Medicine. The main goal is always the value for the patient; simple as that. If you don’t know what I mean with the term “value”, then check one of my previous posts.

Note that the patient word is in singular, not plural. Although the current guidelines may demonstrate that the gold standard for Diabetes treatment is XYZ, EBM may focus on specific patients (i.e. Type I Diabetes patients) to reach a different conclusion. Value for patient is not value for all.

In one sentence: Evidence Based-Medicine is a systematic approach that attempts to answer a medical question by considering the best available clinical evidence and applying strong medical expertise to maximize value for the patient.

Final Words

“But aren’t you going to discuss how EBM applies to business, and what Evidence-Based Marketing is?”

Absolutely, and I’ll do that in my next post. Actually, I hope to make you curious about how this methodology can turn a simple statement into a clinically supported Marketing strategy.

Overall, I urge you to understand and recognize the importance of EBM to business. EBM is a trend that recently gained much strength and will impact the way we do business and promote medical technologies.

See you next week with Evidence-Based Marketing!

Ernesto M. Nogueira