SMD Evidence-Based Medicine

Preface

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1. SMD stands for “Systemic Medicine Doctor” and the domain “SM.Doctor”.
2. SMD Core Philosophy: First principles of health, health systems engineering, and integrated healing through healthcare and wellness.
3. SMD Therapy Characteristics: Organic integration of Chinese and Western medical therapies, psychological therapy, and natural therapies.
4. SMD Evidence-Based Medicine: A closed-loop medical system integrating SMD-Methodology-Driven case analysis, treatment planning, and outcome validation.
5. Human Health Project: A comprehensive health initiative based on SMD methodology.

I. What is Evidence-Based Medicine?

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Evidence-Based Medicine (EBM) is a method of clinical medical practice that takes scientific evidence as its core. It emphasizes the combination of the best research evidence, the doctor’s clinical experience, and the individual needs and values of patients in medical decision-making, so as to improve the scientificity and effectiveness of diagnosis and treatment. Its core concept is to “speak with evidence”, rather than relying solely on traditional experience or personal intuition. Evidence-Based Medicine is becoming the cornerstone of the philosophical methodology of modern medicine, and its essence is a patient-centered scientific decision-making model. It does not deny experience, but rather promotes the shift of medical practice from “experience-driven” to “evidence-driven” by integrating evidence, experience, and patient needs, ultimately achieving safer, more effective, and more humanized medical services.

1. Core Elements of Evidence-Based Medicine

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(1) Best Research Evidence

• It comes from high-quality clinical research (such as randomized controlled trials, systematic reviews, Meta-analyses, etc.) and needs to meet the requirements of scientificity and reliability.
• Evidence Hierarchy Pyramid: The highest level is systematic reviews and Meta-analyses, and the lowest level is expert opinions (such as the research of the Cochrane Collaboration Network).

(2) Doctor’s Clinical Experience

• Combining the doctor’s professional skills and judgment of the patient’s condition to avoid mechanically applying evidence.
• For example, in the case of rare diseases or complex cases, it is necessary to rely on experience to adjust the treatment plan.

(3) Patient’s Individualized Needs

• Respect the patient’s values, wishes, and economic situation, and jointly formulate the diagnosis and treatment plan.
• For example, cancer patients may choose to prioritize the quality of life rather than aggressive treatment.

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2. Practice Steps of Evidence-Based Medicine

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(1) Formulating Clinical Questions

• Transforming clinical questions into retrievable PICO format:
  • P (Patient/Problem): Patient characteristics
  • I (Intervention): Intervention measures
  • C (Comparison): Control measures
  • O (Outcome): Outcome indicators

Example: “For patients with hypertension (P), can taking drug A (I) be more effective in reducing the risk of myocardial infarction (O) compared with drug B (C)?”

(2) Searching for the Best Evidence

• Give priority to using authoritative databases (such as PubMed, Cochrane Library, UpToDate) and screen high-quality research.

(3) Strictly Evaluating the Evidence

• Evaluate the authenticity, importance, and applicability of the research (such as sample size, risk of bias, statistical significance).

(4) Applying the Evidence to Clinical Practice

• Combining the specific situation of the patient and the doctor’s experience to formulate an individualized plan.
• For example, adjusting the drug dosage according to the patient’s liver and kidney function.

(5) Evaluating the Practice Effect

• Tracking the treatment results of patients and optimizing subsequent decisions.

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3. Differences between Evidence-Based Medicine and Traditional Medicine

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Dimension	Traditional Medicine	Evidence-Based Medicine
Decision-making Basis	Personal experience, textbooks, expert opinions	Systematic research evidence + experience + patient needs
Evidence Quality	May be affected by subjectivity	Emphasizing evidence grading (such as the Oxford Evidence Grading)
Patient’s Role	Passively receiving treatment	Participating in joint decision-making
Applicability	Depending on the doctor’s level, may be inconsistent	Standardized process, reducing individual differences

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4. Advantages and Disadvantages of Evidence-Based Medicine

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(1) Advantages

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• Improve the scientificity and transparency of diagnosis and treatment, and reduce subjective biases.
• Promote the transformation of medical research into clinical practice (such as promoting effective therapies and phasing out ineffective measures).
• Optimize the allocation of medical resources (such as avoiding excessive examinations through evidence).

(2) Limitations

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• Evidence Lag: New therapies may lack long-term data support.
• Challenges of Individual Differences: The conclusions of group studies may not be applicable to all patients.
• Risk of Misuse of Evidence: Ignoring clinical experience may lead to mechanical implementation of guidelines.

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5. Examples of Application Areas

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(1) Formulating Clinical Guidelines

• The WHO guidelines recommend the use of glucocorticoids for critically ill COVID-19 patients, which is based on multiple RCT evidences.

(2) Public Health Policies

• Through Meta-analysis, it has been proven that the HPV vaccine can reduce the incidence of cervical cancer, promoting universal vaccination.

(3) Patient Education

• Using concise evidence to explain the “harms of antibiotic abuse” to promote rational drug use.

6. Classic Case

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Controversy over Hormone Replacement Therapy

• Early View: Hormone replacement therapy (HRT) for menopausal women can prevent heart disease (based on observational studies).
• Evidence-Based Revision: The WHI randomized controlled trial in 2002 proved that HRT increases the risks of breast cancer and thrombosis, overturning the traditional perception.
• Result: Clinical guidelines were comprehensively revised, emphasizing individualized assessment.

II. The Essence of Evidence-Based

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The term “evidence-based” in “Evidence-Based Medicine (EBM)” literally means “following the evidence”, specifically referring to taking scientific, systematic, and high-quality research evidence as the core basis in medical practice, combined with the doctor’s clinical experience and the individual needs of patients, to make medical decisions. The essence of “evidence-based” is to use scientific methods to screen the best evidence and guide clinical decision-making, avoiding “assumption” or “empiricism”, and it is the core methodology for modern medicine to move towards precision and standardization.

1. In-depth Explanation of the Three Meanings of “Evidence-Based”:

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(1) Scientificity of Evidence

The “evidence” is not personal experience or traditional practice, but reliable data obtained through strict scientific research methods (such as randomized controlled trials, systematic reviews, Meta-analyses), and it is evaluated and screened according to the evidence hierarchy (such as the Oxford Evidence Grading).

(2) Dynamic Nature of Evidence

With the publication of new research, the evidence base is continuously updated. Doctors need to keep track of the latest achievements (such as through databases like Cochrane Library and PubMed) to avoid relying on outdated conclusions.

(3) Integrativity of Evidence

Relying solely on evidence is not enough. It is necessary to combine:

• Doctor’s Experience: Judging the applicable scenarios of the evidence;
• Patient’s Values: Respecting the patient’s preferences for the risks and benefits of treatment.

2. Comparison with the Traditional Medical Model

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• Traditional Model: Relying on the doctor’s personal experience, textbooks, or authoritative opinions, which may be affected by subjectivity.
• Evidence-Based Model: Standardizing medical behaviors through evidence, reducing blindness and individual differences, and improving the effectiveness and safety of treatment.

3. Typical Case

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For example, in the past, it was believed that “hormone replacement therapy” could widely prevent cardiovascular diseases in women. However, large-scale randomized controlled trials (such as the WHI study) found that its risks were greater than the benefits, prompting the revision of the guidelines - this is exactly the manifestation of “evidence-based”.

III. What is SMD Evidence-Based Medicine?

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SMD Evidence-based Medicine is a medicine that analyzes healing cases, formulates healing plans, and obtains feedback using the SMD methodology (the first-principle philosophy of health / the methodology of health systems engineering / the integrated therapy of medical care and health maintenance).