Well, very important questions.
I feel that many colleagues have "given up" with empowerment of patients,
but I think that the big challange for EBM now should be to bring patients
(and so political representatives, if possible) on our part.
Communicating well to patients, empowering them and their representatives
will induce many of the "powers" (pharma ecc.) to be more careful.
It's a very hard challenge and I think we need to seek collaborations
external to the medical and scientific world (communication sciences ecc).
Very intreaguing for me the reading of Gerd Gigerenzer "Calculated Risks",
2002.
dott. Federico Barbani
Health Purchasing Unit
Health Authority Modena
via San Giovanni del Cantone 23
41100 MODENA
tel 059/435813 - 435731
-----Messaggio originale-----
Da: Evidence based health (EBH)
[mailto:[log in to unmask]] Per conto di Ronan Conroy
Inviato: giovedì 9 luglio 2009 11.36
A: [log in to unmask]
Oggetto: Re: List of biases
On 8 Iúil 2009, at 17:40, Maskrey Neal wrote:
> For me this links into where we're going with EBM. I think we're in
> the 3rd age and tip-toeing into the 4th. EBM v1.0 was conceptual.
> EBM v2.0 was and is technical development - searching skills, MA
> stats etc. EBM v3.0 was and is the industrial age - Cochrane
> collaboration, teaching critical appraisal to anyone who shows
> interest etc. And so I'd profer that if we want to make EBM really
> live for people (cf threads on this group on a number of occasions)
> EBM v4.0 needs to be Customer Focussed. The customers are
> clinicians, patients, commissioners and no doubt others. And if we
> want to reach those groups we need to think about they as humans use
> EBM outputs as information and how they use those to make decisions.
> People need to be careful who they talk to and what they (briefly)
> read.
I think that the major dimension of EBM v4.0 is that if there is a
customer, then there is a profit. 4.0 will have to include an
awareness of the effect that pharma is having on the evidence, by
clever trial design, selective publication, falsification of evidence,
the use of publication companies to place their product in the
literature, by direct-to-consumer advertising and so forth.
The old EBM model of reading each paper as though it were an isolated
- or isolable - entity is flawed. We need to move from checklists for
appraising individual papers to an awareness of the global marketplace
in which this evidence is produced and the massive commercial
interests at stake.
Ronan Conroy
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Royal College of Surgeons in Ireland
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