Evidence-based medicine in the Real World™

I love to see this stuff, and (as you might have guessed) the article was the catalyst for me gushing about the impact of technology on the future of medicine in my primer on evidence-based medicine.

Instead of Willey having to rely strictly on his experience and memory, the computer kicks out the latest information that he can use for his patients.

[...]

For example, Willey showed the computer's reply to a diagnosis of an ear infection that was caused by antibiotic-resistant bacteria. Conventional medicine says the most common antibiotic, amoxicillin, doesn't work on resistant bacteria. But the information in the computer said studies had shown that doubling the dosage of amoxicillin would cure the infection and was safe.

The last paragraph there is quite interesting, incidentally, and it's that kind of thing that makes the idea of evidence-based medicine so titillating. I wouldn't have guessed that, and I bet most docs probably wouldn't either. (Unless they happened to read or otherwise hear of the study.)

I do wonder what the patient thinks when s/he sees the doctor looking things up in the database. Are they worried that the doctor doesn't know his stuff? Are they reassured that the doctor is doing this because he wants to see what the latest clinical findings are? I'd love to take a survey of Dr. Willey's patients to find out. I'm sure younger people are okay with it, but what about the elderly who often have the perception of their doctor as one step below God. (Perhaps an exaggeration on my part, but not by much in some cases).

"The operative words here are 'good science,'" said Dr. Michael LeFevre, medical director for the Department of Family and Community Medicine at the University of Missouri at Columbia. "Decisions are based on evidence that includes consistent results from a number of studies … carried out on a large number of patients in a variety of settings.

But what constitutes good science, I wonder? In my days as a science journalist, I sifted through more crap than I care to recount. Studies that weren't significant, studies that were dubious, studies that didn't really say much at all. Who decides what makes it into the database? Who separates the wheat from the chaff?

I've expressed skepticism about some extraordinary findings here before. If I were a prescriber, how could I be sure that I could trust what's in my clinical database? The skeptic in me is ever-vigilant. I think I'd need a set of standards that each entry to the database has to follow. Probably the most important requirement being that the results had been produced by more than one group.

What do you all think?