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There has been a recent flurry of both lay and scientific discussion over the early detection of cancer.  Questions have been raised about the methods of detection, the quality of the information from the detective strategies, and most of all the value of early detection in determination of treatment and successful treatment.  All of this discussion has once again raised the role of “evidence-based medicine” that Seabrookers and all others desire or need in their individual health care.
  
What is Evidenced-Based Medicine?
This is a relatively newly coined term of a very old concept.  The concept is that a good doctor is one who incorporates a rich professional experience with an up to date knowledge of the latest knowledge concerning the appropriate diagnosis and treatment of an individual patient, namely you.  The evidence that the physician uses is then in three domains, his learning from his own experience in cases such as yours, a sophisticated and current knowledge of the newest and proven approaches to the problem, and a thorough understanding of you, the patient.  The successful blending of these three evidence domains, practice experience, current medical knowledge, and individual patient make for good evidence-based medicine.

Isn’t All Medicine Evidence-Based?
All medicine is evidence based, but the real question is how well is it practiced?  There are examples of physicians who treat similar patients in different ways despite “evidence” in the scientific literature that there are better ways.  This happens when physicians are for many reasons not aware of the latest information.  Another problem is that the scientific evidence which comes from clinical research may have been conducted in dissimilar patients, and it is improper to apply the results to a different type of patient.  Finally, there are trends in medicine as in all society that quickly take hold prior to or without proper scientific evidence – yet it becomes “the thing” to do.  The most notable example are some of the fad diets for obesity that have swept this and other countries and even some of the surgical procedures that were not fully studied before being widely applied by good meaning surgeons.

Quality of the Scientific Evidence
Not all scientific evidence is of similar quality.  There are gradations of information that range from the anecdotal experience with one patient to the results of a very large (lots of patients) randomized clinical trial designed to address a specific question.  The best evidence for any single patient comes from a clinical trial conducted in groups of similar patients with very clear outcomes.  In between these sources of evidence are clinical observational trials on small or large populations, there being less chance of “bad” information or “false positives” from the larger investigations.  The best information for the individual is a so called “prospective – randomized interventional trial” which randomly assigns similar patients to either one form of diagnosis or therapy to patients that have the problem under study.  

Role of the Patient?
You, the patient, are central to this.  It is important when consulting with a physician that you explore the doctors experience and his application to your concerns.  It is vital that when discussing any options regarding your diagnosis and treatment that you ask the physician what the latest scientific evidence is on your condition.  Finally, the patient should always be informed of the risks and benefits concerning any diagnostic test or treatment, so that the patient can have some decision in the course.  In the final analysis, the approach to diagnosis and treatment still remains both science and art. The science comes from the relevant literature and the art from the experience of the physician and the ability to understand and communicate with the individual patient.