In message <01bd5db8$33bf90c0$LocalHost@default>, Stephen Miell
<[log in to unmask]> writes
>If I hear anyone else mention evidence based medicine as some sacred cow
>that daren't be challenged I think I'll scream and scream and scream until
>I'm sick!
>
>Or have diarrhoea.
>
Well don't call your GP! The evidence from this list suggests he or she
will be p****d off about it!
>Seriously, has anyone out there looked at some of the rather exclusive
>criteria which our hallowed colleagues in the sphere of research apply for
>inclusion in the double blind controlled trials upon which we are supposed
>to base our clinical practice in the REAL world of General Practice.
>
>For example a well known trial of anticoagulation in AF excluded the vast
>majority of subjects on the basis that they rather inconveniently couldn't
>be relied upon to take their pills regularly, drank too much, fell over,
>were deaf, or generally were far too unpredictable to be included in such a
>"proper" study of scientific significance.
>
>In other words normal punters excluded, and then next thing you know we are
>all supposed to be anticoagulating everyone who's ever had a few atrial
>ectopics!
>
I think you have the wrong end of the stick. It's by practicing EBM
(actually to be politically correct you have to call it evidence-based
health care now) that clinicians can identify the research questions
which really need to be answered. In general you are right about RCTs -
the more methodologically pure and scientifically valid they are, the
more likely it is that your patient will fail to meet the inclusion
criteria. Knottnerus and Dinant pointed this out recently in the BMJ
(Medicine based evidence: a prerequisite for evidence based medicine.
1997;315:1109-10) and Sackett and Wennberg wrote about "Choosing the
best research design for each question: it's time to stop squabbling
over the "best" methods" (BMJ 1997;315:942-43).
So it's actually EBM which is the driving force behind making
researchers ask questions which address real clinical problems.
>There I feel better now.
>
I hope so
Cheers
Toby
--
Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
0191-2811060 (home), 0191-2437000 (surgery)
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