Is the evidence-based medicine movement counter-productive: are randomised controlled trials the best approach to establish evidence in complex healthcare situations?

Susan Jacups; Clare Bradley

doi:10.1071/phrp3312303

RESEARCH ARTICLE (Open Access)

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Is the evidence-based medicine movement counter-productive: are randomised controlled trials the best approach to establish evidence in complex healthcare situations?

Susan Jacups ^A ^B ^* and Clare Bradley ^A ^C ^D

+ Author Affiliations

- Author Affiliations

^A School of Public Health, University of Queensland, Brisbane, Australia

^B The Cairns Institute, James Cook University, Queensland, Australia

^C South Australian Health and Medical Research Institute, Adelaide, Australia

^D College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

^* Correspondence to: susan.jacups2@jcu.edu.au

Public Health Research and Practice 33, e3312303 https://doi.org/10.17061/phrp3312303

Published: 15 March 2023

2023 © Jacups and Bradley. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.

Abstract

In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with ‘objective’ evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants’ health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.

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