One key element that has received less attention in this thread are
the professional, social and ethical aspects of EBH. We tend to
concentrate on the appraisal of individual studies, and to ignore the
context in which that evidence is gathered (scientific and social)
and the uses to which it is put.
As a possible corrective, I would recommend these starting points:
Ethics: Emmanuel and his colleagues' masterly JAMA paper. Every
student should read it. We get students to appraise a paper ethically
using a template derived from the Emmanuel criteria, and we are also
redesigning our ethics committee application form around the paper.
Paper free; start from here
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10819955
Professional: An understanding of the economics of healthcare
funding, and of how very powerful commercial interests will attempt
to recruit medical professionals. Students love nofreelunch, a
splendid website devoted to briefing them on the bigger picture
behind all those freebies:
http://www.nofreelunch.org
Social: the PLoS collection on disease mongering and the creation of
ill health is a good springboard for discussing the effects on society.
http://collections.plos.org/plosmedicine/diseasemongering-2006.php
I also give them a wonderful paper from Pharmaceutical Executive to
read, so they can see the world the way Pharma does. It includes the
chilling line "It's not just that metabolic syndrome has become
better understood, better publicized, or better supported by an
infrastructure of journal articles, meetings, and associations.
Behind those events and dozens more like them something far more
basic is happening: A new disease is being born."
http://www.pharmexec.com/pharmexec/article/articleDetail.jsp?id=80917
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Ronán Conroy
Royal College of Surgeons in Ireland
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+353 (0) 1 402 2431
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