Evidence Based Medicine: In Its Place

Evidence Based Medicine: In Its Place

Evidence Based Medicine: In Its Place

Evidence Based Medicine: In Its Place

Synopsis

Evidence based medicine is defined as the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients. This superb collection will take a critical view of this concept and examine the economic implications of its imposition.

Excerpt

Gavin Mooney had the great pleasure of meeting Archie Cochrane on several occasions. Archie informed him, after their first meeting in south Wales, that he had revised his opinion of economists. On the basis of the evidence of an afternoon with Gavin, he now placed them second bottom, with sociologists at the bottom. There was much on which they agreed.

Despite his being a Scot, Archie's generosity was legendary. On hearing that Gavin needed £1,000 (little short of a year's salary for Gavin then) to get his fi]rst book published (the publisher had indicated that it was unlikely to be a best-seller), Archie arranged for a 'trust' that he 'chaired' to pay. Gavin is certain that the money came from Archie's own pocket.

Fond memories of a man of stature, humour and generosity …

One can only wonder what he would have made of the Cochrane This and the Cochrane That. Certainly then he was all too well aware that evidence depended very much on how it was presented and the values brought to its interpretation. As at that time a very junior member of staff at the Department of Health in London, Gavin recalls how Archie presented evidence from a randomized controlled trial (RCT) on treatment of heart attacks. the learned doctors nodded sagely when he reported that the evidence showed that treatment in hospitals was superior to treatment in the community. It was only when Archie 'confessed' to having got the figures round the wrong way that the learned nodders sought to question the study design!

In 1974, Ivar Sønbø Kristiansen started his medical career as a gp in a remote area of Norway. He soon upset his senior hospital colleagues by asking awkward questions about the 'evidence' for therapies that were at that time mainstream. For example: 'Why should we make young girls subject to unpleasant radiology examinations and possibly subsequent urinary surgery when they have had two or three urinary tract infections?' Hospital colleagues angrily responded that it would be better for the girls to experience some unpleasant procedures than suffer renal failure and death as a result of recurrent infections. Some of these procedures are now seen as obsolete.

For a sceptical doctor, it was a memorable moment to open the first

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