According to Evidence Based Medicine (EBM), healthcare professionals should make conscientious, explicit and judicious use of current best evidence in their daily practice.1
How does one come to do this?
Clinical practice guidelines are systematically developed statements to assist practitioners with decisions about appropriate health care for specific patients’ circumstances.2
In medicine scientific evidence is classified as follows:
- Level of evidence A: recommendation based on evidence from multiple randomized trials or meta-analyses
- Level of evidence B: recommendation based on evidence from a single randomized trial or nonrandomized studies
- Level of evidence C: recommendation based on expert opinion, case studies, or standards of care.3
Once the level of evidence has been reviewed, recommendations can be made. These recommendations are also classified:
Class I: conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective
Class II: conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
Class IIa: weight of evidence/opinion is in favor of usefulness/efficacy
Class IIb: usefulness/efficacy is less well established by evidence/opinion
Class III: conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful.
Thus, level of evidence C and class II indicate, respectively, recommendations lacking supporting evidence and those subject to uncertainties about the appropriate medical decision.3
Using techniques from science, engineering and statistics, such as the systematic review of medical literature, meta-analysis, risk benifit analysis, and randomized control trials. Ex cathedra statements by the “medical expert” are considered to be least valid form of evidence. All “experts” are now expected to reference their pronouncements to scientific studies.3
Based on this set of guidelines, can we classify religious writings like the Bible, the Bhagavad Gita or for that matter any religious book?
Let us give it a whack…
Is any of these books based on multiple randomized trials or meta-analyses?
One randomized trail or nonrandomized studies?
Is it based on expert opinion, case studies or standar of care?
Yes (even this Yes is up for debate)
So, according to this review, the Bible and other religious books are a Level of evidence C.
And now, on to set the class recommendation.
Following the evidence this type of writings must be a Class III ( “Class III: conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful”.)
So if the Bible or any religious writing were subject to evaluation of scientific evidence it would ultimately be seen as Level C and Class III, not acceptable as grounds for any kind of treatment, in fact you would most likely be setting yourself up for a nice malpractice lawsuit if you based your treatment on this level of evidence.
2 Lohr K, Field M. A provisional instrument for assessing clinical practice guidelines. In Guidelines for Clinical Practice From Development to Use Edited by Field M, Lohr K. Washington DC: National Academy Press; 1992.
3 Tricoci, P., Allen, J. M., Kramer, J. M., Califf, R. M., & Smith, S. C., Jr. (2009). Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA: the journal of the American Medical Association, 301(8), 831–841. Am Med Assoc.