Hi
SRs have been done not only the effectiveness of clinical procedures and medicines, but on lifestyle interventions.
Wouter, I'm not sure what problem you are identifying. Is it: SRs themselves (the SR as a method); or the fact that many SRs in health do have a focus on medical interventions (though some concern public health and health promotion interventions - and as others have noted, there are SRs of qualitative research which tends to take account of the wider context of individuals' lives); or the fact that guidance to health professionals based on SR findings may not always relate to the individual patient's context? Or something else?
I disagree that SRs are futile. Surely where good SRs are lacking, there is greater scope for 'the shareholders of the pharmaceutical industry' to influence clinical practice and health policy?
Best wishes
Catherine
Disclaimer: author of one cochrane SR, done without funding, because of interest in the topic, to assist a colleague, for the research experience, and - I can't deny it - to benefit my CV.
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Wouter Havinga
Sent: 05 December 2015 10:53
To: [log in to unmask]
Subject: Re: Why do we do systematic reviews?
Dear Jon,
My opinion about (the futility) of doing SLRs is that doctors do not do what Ian suggests: "to use their own clinical judgment and personal experience".
For example, with reference to SSRIs I believe that doctors are ignorant or arrogant to address their own capacities to deal with their own and their patient's emotional issues and life events other than giving out a tablet. Of course that doctor behaviour is maintained by the wishes of the patient for a "quick" fix.
That ineptitude shows in most of chronic disease 'management'. Chronic disease is often due to life style issues, but are (out of convenience) not managed by the patient nor the health professionals.
No doubt the current established doctor and epidemiology community will conveniently keep occupying themselves with SLRs. However, hopefully medical education will renew itself and focus on what matters to people rather than the shareholders of the pharmaceutical industry.
This article in BMJ Open is hopeful "Medical education and training - Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study" http://bmjopen.bmj.com/content/5/12/e009593.full
To me it seems that the reasons SLRs are done:
- convenience (avoid addressing the real (personal) issues
- to maintain personal income
Best regards,
Wouter (GP - family doctor)
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