Part of the problem with talking about evidence based health is that the
term immediately evokes emotions - both positive and negative so I find it
useful to avoid using the term at the start of a seminar.
A way that I find works is to start off with beliefs that are
non-threatening and kind of fun. If you start off by using beliefs that no
one really cares too much about it facilitates a discussion of beliefs and
evidence.
A) NON-THREATENING BELIEFS
1) Wait for one hour after eating before you swim - we all did this as kids
There is no evidence to support this belief that I know of
2) Don't go outdoors with your hair wet, or you'll catch a cold - all our
mothers told us this
Cold viruses are passed primarily by sneezing or contact with another
person's mouth or hands etc
I also believe there was a study done in army recruits where they showered
and then stood them out in the cold and they didn't get more colds - if
anyone knows where this trial is please let me know.
B) FOOL THEM WITH NUMBERS
STUDY EXAMPLE
I also use the example of fooling them with numbers - although this is
getting harder all the time
Imagine that you just found out you have a risk factor for cardiovascular
disease (e.g., high blood pressure or high cholesterol).
A drug that will treat this risk factor is available and it has no side
effects and its cost is covered by a plan.
Consider the following three scenarios.
Would you be willing to take this drug every day for the next five years if
it had been shown in a clinical trial that:
1) patients treated with this cholesterol pill had been shown to have 33%
fewer heart attacks than the non-treated patients; or if
2) it was found that 2% of the patients who took this cholesterol pill had a
heart attack, compared to 3% who did not take this pill - a difference of
1%; or if
3) in 100 patients who took this cholesterol pill for five years the
medicine would prevent one of the 100 from having a heart attack. There is
no way of knowing in advance which person that might be?
MONEY EXAMPLE
I ask how many would like to get the following letter from their bank
Dear Valued Customer:
It is our pleasure to announce that effective immediately, our bank is
reducing all mortgages by 30%.
And then I ask them if they have a mortgage - many don't so they have saved
30% of nothing
c) PERSONAL BELIEFS
Another excellent way (if you have the time or if it can be done ahead of
time) is to get the participants to identify a belief they have about a
particular area of medicine and then get them to find the evidence to
support their belief - almost without exception, the strength of the
evidence pales in comparison to the strength of their belief
You can then work your way into more concrete and more emotion laden
examples - CAST trial, HERS trial, ALLHAT trial etc etc.
I have a Word document which is a compilation of 1/2 page synopses of 30 or
so clinical trials that are useful to show when reviewing EBM concepts. If
anyone is interested I would be happy to send it to them.
Hope this helps.
-----Original Message-----
From: Evidence based health (EBH) is the integration of individual
knowledge [mailto:[log in to unmask]]On Behalf Of
Ghosh, Amit K., M.D.
Sent: Wednesday, March 21, 2001 9:00 AM
To: [log in to unmask]
Subject: Re: Understanding in hostile territory
Another good article is
How to read clinical journals: X. How to react when your colleagues haven't
read a thing
S.L. Shumak, D.A. Redelmeier CMAJ 2000;163(120:1570.
Amit K. Ghosh, MD
Rochester , MN USA
> ----------
> From: Dr. Giuseppe Giocoli[SMTP:[log in to unmask]]
> Reply To: Dr. Giuseppe Giocoli
> Sent: Wednesday, March 21, 2001 9:01 AM
> To: [log in to unmask]
> Subject: Understanding in hostile territory
>
> Dear Toby,
> "Vae victis!" (Woe to the conquered!) Brenno shouted at Romans, throwing
> his sword onto the scales, while they weighing their tributes.
> "Woe betide aliens!" I said today morning while reading your sentence:
> "OK, this 30 year old medical negligence solicitor who jogs every day
> wants a provate referral for exercise ECG ....".
> I cannot understand which kind of person is the one you are speaking
> about.
> Toby, you often hide crystalline concepts inside a cover of very hard
> English ...
> I would kindly remind you Britons that a lot of aliens are listening in
> the list.
> Thanks.
> Giuseppe
>
>
>
> Dr. Giuseppe Giocoli
> Via Sarca, 19
> 25015 DESENZANO d/G (BS) Italia
>
>
> At 11.01 21/03/01 +0000, you wrote:
>
>
> In message <[log in to unmask]>, K.Hopayian
> <[log in to unmask]> writes
> >I am booked to give an introductory talk to two groups of general
> >practitioners in this part of England, East Anglia. The first is a
> group of
> >GPs attending an annual refresher course, the second a group of
> trainers and
> >their trainees (called registrars in England). Both groups contain
> >individuals hostile to EBM (though none have had direct exposure, I
> >suspect).
> >
> >My plan is to use *educational aikido* - that is, let them attack
> and I will
> >use their own force or weight to floor them. I believe I can
> predict what
> >they will say and so have some examples to give to illustrate that
> EBM is
> >not the monster they believe and that it can help answer questions
> that
> >arise in general practice.
> >
> >I have never done this before so I wonder if any of you have
> experience I
> >could benefit from?
> >--
>
> I tend to give a broad historical introduction using examples of
> failure
> (or delay) in getting research into practice. The examples I use
> are:
> Lind's work on scurvy, Semmelweiss's work on puerperal fever (with
> the
> added twist that Oliver Wendell Holmes came to the same conclusion,
> but
> they were never in contact) then leap forward to CAST and
> thrombolysis
> (if they thought "of course WE are too sophisticated to ignore
> evidence..."). Then I work through an example of diagnosis (exercise
> ECG
> for super-fit athlete with non-cardiac chest pain). All the time I
> emcourage discussion. This seems to go down OK - it seems a common
> misconception is still the old one about "cookbook medicine", so
> it's
> useful to cover ground where preconceptions can be challenged ("OK,
> this
> 30 year old medical negligence solicitor who jogs every day wants a
> provate referral for exercise ECG and will make a formal complaint
> if
> you don't comply...what do you do?" -there's always an honest one
> who
> says "OK, I'll refer - what harm can it do?!!")
>
> Toby
> --
> Toby Lipman
> General practitioner, Newcastle upon Tyne
> Northern and Yorkshire research training fellow
>
> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>
> Northern and Yorkshire Evidence-Based Practice Workshops
>
> http://www.eb-practice.fsnet.co.uk/
>
>
