Introduction
There is a crisis in ‘evidence-based medicine’ (EBM). Reviewers and meta-analysts have become aware that much of their work may be futile because some investigators only publish selected results that favour their own point of view. Such reviews can only be reliable if there is access to all the raw data or if everyone is compelled to publish ‘negative’ results too. This is proving difficult and controversial. The latest example is dabigatran, which was hailed as a safe advance that needs no coagulation monitoring. It seems that the reduced frequency of bleeding if there is coagulation monitoring was not reported. There is also widespread uncertainty about the thresholds for treatment. This has been highlighted in the ‘over-diagnosis campaign’ to address a concern that many patients are subjected to harm without much benefit. Many see the problem as one of vested interest e.g. where those who gain from supplying a treatment will tend to advocate a low threshold for treating whereas those who wish to reduce costs or effort prefer to set high thresholds. The evidence needs to support what is best for the patient and gathered by those who care for them e.g. acute medicine physicians.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]
References
- Greenhalgh P. Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ 2014; 348: g3725.
- All trials campaign. Open letter: European Medicines Agency should remove barriers to access clinical trial data. BMJ 2014;348:g3768
- Cohen D. Dabigatran: how the drug company withheld important analyses. BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4670
- Llewelyn D E H, Garcia-Puig, J. How different urinary albumin excretion rates can predict progression to nephropathy and the effect of treatment in hypertensive diabetics. JRAAS 2004, 5; 141-5.
- Llewelyn H, Ang AH, Lewis K, Abdullah A. The Oxford Handbook of Clinical Diagnosis, 3rd edn. Oxford: Oxford University Press, 2014.
- Llewelyn, H. How to promote and support a culture of patientcentred openness and transparency in the NHS. International Journal of Clinical Practice 2013, 67, 10, 943–946.
- RM TempleR M, Donley A. The future hospital – implications for acute care. Acute Medicine 2014, 13, 1, Pages 4 - 5
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
