Poor Evidence Based Medicine
Even though the advantages of negative pressure wound therapy cannot be confirmed with any degree of certainty on the basis of the criteria of evidence based medicine (EBM), the procedure has greatly gained in importance in a wide range of surgical interventions, and rightly so. The advances prompted by this method are probably obvious only to those who experienced the time before it was introduced, which is longer than 20 years ago.
After 29 years’ activity in the specialty I can honestly say that the development of negative pressure wound treatment constituted one of the largest advances in surgery during this time.
There is a multitude of wounds and defects in abdominal-trauma-vascular surgery and related disciplines that were almost unmanageable in the past without extensive aids and patient transfers to maximum care hospitals, but which nowadays can be managed successfully in any basic surgical ward. This makes the frequent, irritating problems with reimbursement of costs in the outpatient setting—because the effectiveness of the method has allegedly not been confirmed—even more irritating. No alternative treatment method is supported by better evidence, but none of them incur similar problems in terms of costs being covered.
This example illustrates the two weaknesses of the concept of pure EBM, at least in the way it is practiced in Germany. One is an inherent aversion to progress and advances in the system, the other is the fact that any novel procedure can be made into an instrument of financial politics.
To restrict EBM to a few randomized controlled trials, which means basing whole truths on such a sparse foundation, and to ignore the entire empirical proofs accumulated over time is not a satisfactory concept within surgery; neither does it reflect the original ideas of evidence based medicine. But this incomprehension of what EBM actually is provides politicians and health insurers with easy reasons to reject ideas.
Dr. med. Hanspeter Thies
Kreiskrankenhaus Abteilung Unfallchirurgie, Zwiesel
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Peinemann F, Sauerland S: Negative pressure wound therapy – systematic review of randomized controlled trials. Dtsch Arztebl Int 2011; 108(22): 381–9.|