Higher Levels of Evidence Sought by Members of New Veterinary Association
Obtaining the highest level of evidence for research and practice is the primary goal for members of the Evidence-Based Veterinary Medicine Association (EBVMA), which was formed in June 2006. The group has 40 members including veterinary specialists, professors, librarians and private practitioners who question the quality of findings in textbooks and clinical trials that, they say are difficult to verify, not species-specific and may be outdated.
“A lot of the work published is based on uncontrolled trials or trials in other species so we have to extrapolate,” said Bob Larson, DVM, PhD, and president of the EBVMA. “That is not considered to be a high-level of evidence.”
Veterinary professionals have discussed evidence based medicine online at the Veterinary Information Network (VIN), said Paul Pion, DVM, DACVIM. A VIN consultant, Pion said, “the bottom line is that veterinarians like to think they’re practicing based on evidence but we’re starting to wake up to the realization that the [objective scientific] foundation of textbooks, review articles and lecturers is nowhere near where [the level] we believed it to be.”
Pion hopes that the EBVMA is a step in the right direction. “We recognize that there’s a void of evidence,” Pion said. “The question is, ‘how far into the void are we?’”
Online Searches vs. Textbooks
Larson believes that two inherent weaknesses of textbooks is a lengthy publishing timeframe and lack of peer-reviews. Most importantly, he said, “the data is not transparent, so you cannot verify the information.”
Pion agreed and said that the availability of raw data as well as a more inclusive and collaborative approach to research will benefit the profession overall. “We have to work for the greater good,” he said, “not the ego.”
EBVMA members prefer computer-generated searches with clearly-identified pathways to verify the information. They hope to swap textbooks for such online searches, and seek controlled studies that will, according to Larson, result in “more teachable” professionals who question shaky data and recognize that diagnoses and prognoses may be different in a few years. “Our emphasis is to help students learn to search and find the very best level of evidence available. Our intent is not to knock textbooks but to emphasize the power of online searches,” Larson added.
Andrew Maccabe, DVM, MPH, JD, questions claims about shaky veterinary data, and said he is confident that published veterinary medical findings are sound.
“There is a strong and robust body of literature in the scientific press that is of extremely high quality. This published, peer-reviewed literature forms the very foundation of a science-based profession, such as veterinary medicine,” said Maccabe, associate executive director of the Association of American Veterinary Medical Colleges.
Evidence-based medicine has been embraced by some human doctors and several books including Evidence-Based Medicine: How to Practice and Teach EBM have been written about the topic.
Larson, a professor of clinical science at Kansas State University, started talking about the need for a group like the EBVMA with colleagues in 2004. He has broached the topic with his students at KSU for the last three years, and the reactions to the concept of evidence-based medicine have been mixed.
“Some students like the world to be more black and white,” Larson said. “They’d like facts to remain facts.”
And while Larson can appreciate that perspective, he has had firsthand experience with discovering that the things he learned as a medical student are no longer true, that new discoveries made initial findings obsolete.
Preparing students for that reality, and teaching them how to ferret out the latest and greatest findings is a goal for the EBMA. “We want to teach students how to stay up to date and get the best data, a process that is much easier with computers and Medline," he said.