Evidence Label = Jangan Mudah Percaya Issue

Sekarang ini segala sesuatu modah ter-blow up akibat sistem informasi yang sangat canggih, Via TV, internet dan lainnya. Silakan lihat sendiri di milis2.

Contohnya masalah thimerasol pada vaksin hepatitis yang "katanya" bisa menyebabkan autisme, Fetal Hiccups dapat menyebabkan autisme dan lain2. Yang mana hal2 seperti ini akan membuat orang awam menjadi khawatir dan parno...Ibarat kata pepatah akibat susu setitik rusak nila sebelanga (pepatah modern...)

Dalam ilmu kedokteran dikenal istilah Evidence Based Medicine :"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

Berikut ini tahapan2 dalam EBM:

The patient	1. Start with the patient -- a clinical problem or question arises out of the care of the patient
The question	2. Construct a well built clinical question derived from the case
The resource	3. Select the appropriate resource(s) and conduct a search
The evaluation	4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)
The patient	5. Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice
Self-evaluation	6. Evaluate your performance with this patient

Evidenve Label
Berdasarkan Guideline Recommendation and Evidence Grading - GREG

• Evidence grade:
  • I (High): the described effect is plausible, precisely quantified and not vulnerable to bias
  • II (Intermediate): the described effect is plausible but is not quantified precisely or may be vulnerable to bias
  • III (Low): concerns about plausibility or vulnerability to bias severely limit the value of the effect being described and quantified
• Recommendation grade:
  • A (Recommendation): there is robust evidence to recommend a pattern of care
  • B (Provisional recommendation): on balance of evidence, a pattern of care is recommended with caution
  • C (Consensus opinion): evidence being inadequate, a pattern of care is recommended by consensus

Berdasarkan Agency for Health Care Policy and Research (AHCPR):

• A: requires at least one randomised controlled trial as part of the body of evidence.
• B: requires availability of well-conducted clinical studies but no randomised controlled trials in the body of evidence.
• C: requires evidence from expert committee reports or opinions and/ or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality.

Rekomendasi yang dipakai AAFP (American Academy of Family Physician)

• Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies.
• Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies and case-controlled studies with nonbiased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiological studies with compelling findings, is also included.
• Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Penutup
Kebanyakan issue yang di blow-up pada umumnya masih dalam level C, yang tentunya sangat lemah. Kasus yang timbul sering digeneralisir oleh orang awam. Padahal expert menyatakan sesuatu juga memang berdasarkan EBM tetapi dengan level terendah dan masih dibutuhkan penelitian lanjut.