Phil . Hall wrote:
> I believe that you are referring to an article under that or
> a very similar title by Dr. Geoff Norman at McMaster
> University, published I believe in the mid '90's.
Unless I'm mistaken, I believe the SR Drs. Gutherie and Sontheimer were
referring to was the one by Chris Hyde et.al. funded by the UK National R&D
Programme released August 2000. It is the most comprehensive SR on the
effectiveness of teaching critical appraisal (CA) to date and shows CA
teaching improved knowledege of and attitude towards CA, weakly improved CA
skills and may have increased journal article reading. All outcomes were
short term (less than 12 months). No studies examined the effect of CA
teaching on patient outcomes, self learning behaviors, clinical decision
making or learner satisfaction, arguably the only "important" outcomes; the
others being surrogate markers of uncertain validity.
Ken
NH Jacksonville
Department of Family Practice
(904) 777-7963 dsn 942
-----Original Message-----
From: Philip Hall [mailto:[log in to unmask]]
Sent: Friday, June 01, 2001 10:32 AM
To: [log in to unmask]
Subject: Reply: Is EBM effective?
> June 1 2001 ("rabbits!")
>
> I believe that you are referring to an article under that or
> a very similar title by Dr. Geoff Norman at McMaster
> University, published I believe in the mid '90's.
>
> I agree that EBM use, teaching of its use, and adoption of
> its methods are not the same thing as achieving longer or
> better quality of life (subject to the definition of the
> latter). There is excellent evidence from Kahneman, Tversky
> and others that human decision making given uncertainty is
> irrational, and lots of evidence elsewhere that unsupportable
> but habitual interventions persist, and that effective ones
> are adopted slowly at best.
>
> There are other relevant questions as well that have not been
> addressed in evaluating the EBM effect, whatever it is. One
> is whether the appropriate outcome measures have been sought.
> Another is whether they have been sought for long enough. The
> list goes on.
>
> Perhaps the human species has become relatively resistent to
> ineffective interventions, and somehow survives despite most
> of them. Someone - I would love to know who - said "Life is
> too short to drink bad wine." Perhaps critical appraisal, or
> as Norman once called it "CRAPP DETECTION" and EBM are
> methods to assess whether the wine is good or bad, before drinking it.
>
> Sincerely,
> Phil . Hall
> Maternal & Fetal Medicine
> University of Manitoba
> Winnipeg, Manitoba, Canada
>
> >>>My take on this SR was that is why this list has been
> relatively quiet, of
> late. Two years ago, when I joined, there would at least be
> 2-3 posts per
> day. Now the volume appears less to me. I have no doubt
> right now that all
> we can say about EBM is that it can make practices more
> evidence-based.
> Helping patients live longer or with better quality of life
> is an entirely
> different matter. I remember seeing an excellent article
> (but now have
> lost the reference) titled something like "A Critical
> Appraisal of Critical
> Appraisal". It wasn't kind to EBM, and really spoke to the
> need for the
> questions brought up by these posts.
>
> I think EBM is good, even if all it does is make practice more
> evidence-based. I think patients deserve therapies that have some
> foundation, as opposed to tradition or whimsy. I think this
> is why we will
> see EBM evolve along with reflective practice to create an
> environment,
> where science and art can compliment one another.
>
> Dan Sontheimer
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