Barriers to evidence based medicine practice in South Asia and possible solutions

The South Asian countries share common health challenges with very poor health indicators in the world. This is primarily because of political apathy, poverty and staggering health infrastructure. In resource-limited countries, an evidence-based approach can rationalize the treatment and be costeffective by reducing clinical practices that have no proven benefit. However, at present, evidencebased medicine is virtually non-existent because of its inherent complexity, misperceptions, absence in medical curriculum, rigidity and unawareness of practicing clinicians and misinformation. The fundamental steps to bridge these barriers include effective teaching of skills of evidence-based medicine during residency, motivating the established clinicians, constraining malpractice, formulating locally applicable guidelines, increasing the accessibility to internet, availing telemedicine facility at peripheral centers and disseminating appropriate information via free journals or even newspapers. In association with strong political commitment, these steps can lay the foundation stone of evidencebased practice in SAARC region. Despite this gloomy picture, the overall economic growth of South Asian countries in the past decade and practice of evidence-based medicine in some tertiary care centers are a ray of hope. Neurology Asia 2008; 13 : 87 – 94 Address for correspondence: UK Misra, Prof. & Head, Department of Neurology, Sanjay Gandhi PGIMS, Rae Bareily Road, Lucknow 226014, India. Fax: 91-0522-2668017, Email: [email protected], [email protected] INTRODUCTION The South Asian region comprising of 8 countries, is diverse in geographical, linguistic and cultural characteristics but has common health challenges. It harbors one-quarter of World population but bears a triple burden of persisting infectious diseases, increasing chronic conditions and a growing rate of injuries and violence.1 Evidencebased medicine (EBM) defined as “the process of systematically finding, appraising, and using contemporaneous research findings is the basis for clinical decisions”. This concept was proposed by Gordon Guyatt at McMaster University in Canada in 1992.2 Though the framework of EBM was laid in West, its basic essence seems to have existed in Asia long before its formal inception. South Asian countries and their societies are influenced by several faiths and religions like Hinduism, Islam, Jainism, Buddhism and Sikhism. These religions are variably scientific, logically defined and can be adaptable to change. It is difficult to believe that countries with such a rich cultural and ethnic heritage have not yet adapted the concept of EBM. Possibly, the problems with acceptance of EBM are not unique to EBM, rather reflect the overall poor socio-economic status of this region which itself is a major hindrance in health delivery. SPECIAL RELEVANCE OF EVIDENCEBASED MEDICINE TO ASIAN