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The frustrations expressed by the practitioner in the following scenario are echoed by thousands of healthcare providers who attend to the millions of patients in developing countries all over the world. The problems are depressing, and even for our sympathetic colleagues from the developed world, it may be difficult to understand the cynicism and desperation. This editorial attempts to answer 3 important questions on the relevance of evidence-based medicine for developing countries by drawing from experience in the Philippine setting.
Scenario
You are a facilitator conducting an evidence-based medicine workshop for a group of rural practitioners in a remote barrio in the Philippines. Suddenly, an exasperated participant breaks his silence. “All of this science sounds really good, doctor, but I practice in a small town where I see very poor patients. We don't have computers and medical libraries, you know. In fact, we sometimes don't even have electricity. How relevant can evidence-based medicine be in our setting?” A tension-filled pause follows as you sit still, eyes downcast, trying to prepare a reply. What would be your response?
DO WE REALLY NEED EVIDENCE-BASED MEDICINE IN DEVELOPING COUNTRIES?
Limited resources
In many developing countries, the bulk of healthcare expenditures continues to be shouldered by individual patients or their families. Thus, nothing could be more appalling than a physician ordering unnecessary tests or prescribing inappropriate treatments for indigent patients. However, throughout the Philippines, for example, resting electrocardiograms (ECGs) are routinely done in asymptomatic patients to screen for coronary artery disease (CAD). The test costs approximately US$5, enough to provide 3 full meals for a family of 5. A careful appraisal of the evidence would have revealed to practitioners that resting ECGs are virtually useless as a screening instrument for CAD.1
As this example illustrates, the practice of evidence-based medicine in developing countries could save millions of dollars in health expenses, with the ultimate beneficiary …