I'd like to go on the record for saying that I agree and disagree with the
statements that were posted. (See below.) There's a common misconception
that evidence-based medicine excludes or belittles experience or clinical
intuition, which it does not. If you go back and read the original writers
on this topic, they make that very, very clear.

Evidence-based practice isn't the be-all and end-all. One of the problems
with "evidence" is that many of the study results emanate from poor
research designs, or the studies that we cite aren't generalizable to the
population we work with. As my beloved father frequently reminded me,
"Statistics lie, and liars make statistics!"

Some of us were using evidence-based practice before the guys writing about
it nowadays coined the term. Only recently, when purging some old files, I
found a breastfeeding protocol that I wrote in the early 1980s which gave
citations for my recommendations. There you go: Evidence-based practice!

Evidence-based practice helps us to avoid the pitfalls of "common sense" or
what everyone just "knows" to be true, and what later proves to have no
basis in scientific fact. For years, we all "knew" that drinking 8 glasses
of water a day would make make more milk, but thanks to two studies by
Dusdieker et al (as well as others) we soon learned that what we "knew" to
be "true" simply wasn't.

On the other hand, there are still a boatload of clinical issues which
simply aren't addressed in published studies. We can't sit around waiting
for the problem to resolve itself until a double-blind, randomized,
conclusive study--generalizable to all populations--drops out of the
evidence-based sky.

So, if I appear to be talking out of both sides of my mouth, I'm not.
Experience and intuition, while essential to clinical management--is not
enough. If there's evidence, we need to use *and* scrutinize its
methodology and appraise its relevance for the population we're dealing
with. In the absence of clinical evidence, however, we need to use our
experience and intuition.


>Good one Jennifer. That's what I've been saying for years. "Evidence based
>medicine", good in theory, is in fact, only for putting down the opposition.
>"When I don't agree with someone, I demand evidence based medicine, and send
>them scurrying to the library, where they won't bother me for a while.  But
>when I want to do or say anything, my experience or my intuition are
>enough".


--
Marie Biancuzzo, Perinatal Clinical Nurse Specialist
[log in to unmask]
Resources to simplify breastfeeding management are available at
http://www.wmc-worldwide.com

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