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OB/GYN Editorial November 2001

Evidence-Based Medicine, Revisited

Lee P. Shulman, MD

Clinicians look increasingly to evidence-based medicine for guidance in their work. Elaboration of scientific and clinical information serves to provide much-needed direction in patient care. Indeed, two recent articles shed light on clinical practices that have not been widely accepted by practitioners in the United States but that may soon become adopted as a growing body of supporting evidence becomes even more compelling. Use of intrauterine contraception in the United States has been limited by fears of resultant complications and infertility, as well as the ensuing potential for legal redress. A recent prospective study has shown that infertility risk was no higher among women who had used a copper intrauterine device for contraception than among women who did not.¹ We can only hope that evidence-based medicine will convince clinicians of the overwhelming benefits of intrauterine contraception for those women who desire long-term, reversible birth control and who are good candidates for these devices.

Another recent prospective study explored the controversial issue of hormone replacement therapy (HRT) use in breast cancer survivors.² Researchers "observed lower risks of recurrence and mortality in women who used HRT after breast cancer diagnosis than in women who did not," and concluded that "although residual confounding may exist, the results suggest that HRT after breast cancer has no adverse impact on recurrence and mortality." Such findings are likely to be met with surprise by some and disbelief by others. And yet, when researchers publish studies that may not have been performed rigorously but that reinforce concepts already embraced by many professionals and laypersons, such studies are heralded as "proof" of a particular tenet.

We professionals must appraise the literature in its entirety. If we are to offer our patients the most precise diagnoses and the most effective treatments, not to mention the best advice regarding disease prevention, we must keep informed about the latest studies and re-evaluate previous findings with an open mind.

That is the reason that peer-reviewed -journals such as THE FEMALE PATIENT® are so useful; they keep us informed about recent clinical developments and help us to put the new information in perspective. With a plethora of journals and articles to choose from, we can decide for ourselves how to best accomplish this goal.

Lee P. Shulman, MD
Editorial Board Member

References

1. Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345:608-610.
   
2. O'Meara ES, Rossing MA, Daling JR, et al. Hormone replacement therapy after a diagnosis of breast cancer in relation to recurrence and mortality. J Natl Cancer Inst. 2001;93:754-762.

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