> I take issue with the definition of evidence-based medicine
implied.
Leaving aside formal definitions, I think you can argue that one
effect of the evidence based medicine focus on hierarchies of
evidence is that in some situations for some people, 'no rct' is
taken to be synonymous with 'no evidence'.
Cochrane is a major example of this (and David was careful to say
ebm in the sense of systematic reviews not ebm in the sense of
clinical practice - although there is another strand of ebm which
holds up systematic reviews as the ideal thing for clinicians to
read....).
For most of the Cochrane review groups, it isn't actually possible to
reach any very definite conclusion if there isn't rct evidence, no
matter what other research has been done (there are exceptions to
this eg the effective practice group, although they still only allow a
limited number of methods as 'acceptable', and I'm aware that there
is a non randomised studies methodology group looking at this).
It probably is too broad brush to distinguish broad churches like
ebm and hta like that, but I think David is making an important, real
distinction between two ways of thinking.
Bruce
Bruce Guthrie,
MRC Training Fellow in Health Services Research,
Department of General Practice,
University of Edinburgh,
20 West Richmond Street,
Edinburgh EH8 9DX
Tel 0131 650 9237
e-mail [log in to unmask]
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