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As medical professionals, we are encouraged to champion the maxim of evidence-based medicine, which is that the best approach to patient care is using the best current evidence from well-designed and conducted research studies. But what happens when we try to apply these principles to a society that has different ideals?
Evidence-based medicine involves 2 fundamental principles. First, evidence alone is never sufficient to make a clinical decision. External evidence can inform but never replace individual clinical expertise. Second, the physician needs to consider the patient’s values. Imagine that you live in a place like Tanzania, where, for over 200 years, “doctors” have been preaching a different kind of medicine. You are told that disease and illness are due to black magic or a curse wrapped up in religious fervor. All of your family and village believe in these traditions while also believing that those who go to westernized hospitals will suffer. How do you think you would react to unfamiliar treatment based on distant principles?
Sawers N. Evidence-Based Medicine vs Traditional Healers in Africa. JAMA Ophthalmol. 2016;134(10):1085-1086. doi:10.1001/jamaophthalmol.2016.2493