How to implement medical evidence into practice in developing countries

Sackett and colleagues first defined evidence-based medicine as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”.1 Integration of the best research evidence with clinical expertise and patient values is the key element for evidence-based practice. Good judgment is crucial when it comes to evaluating the evidence and implementing it.2 Evidence-based medicine is not “one size fits all”, as the world is highly diverse concerning patterns of diseases, economy, and societal values. This article documents the peculiarities of developing countries regarding evidence-based practice and presents a simple education model for the transformation of evidence into practice for undergraduate and postgraduate students. Developing countries and evidence-based medicine Developing countries have multiple issues when it comes to evidence-based medicine. First of all, most of the evidence is imported. If we take all Arab countries as an example, their medical research production over an 18-year period is just 3% of the USA’s production.3 Therefore, the best scenario is that 97% of their practice is based on evidence that was not specifically generated for them. This is unsatisfactory as every society, ethnic group, or even culture has its unique diseases or different forms of the same disease, different responses to therapeutic modalities, different resources and personnel qualifications, and perhaps also different values and patient preferences. Secondly, critical appraisal skills are poorly developed among health care professionals4 and their incorporation into the curriculums of medical schools is limited.5 Consequently, this may result in the adoption of unnecessary practice or improper use of the evidence. Furthermore, it may lead to “jerky medicine syndrome”, the term I use when physicians frequently change their way of practice in response to their latest reading of the literature. Ideally, the medical practice should be consistent with few sudden changes, otherwise achieving competence among the staff will be very difficult and could potentially lead to increased patient morbidity. The final issue regarding practicing medicine in developing countries is that the regulatory bodies of medical practice are less well established and not as empowered. As a consequence, national guidelines are either absent, unclear, or copied from international guidelines.