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Hi Martin, Welcome to the listserve. I am really glad that you asked this question. While EBM is about making the evidence easier to use, it is also about becoming a more informed consumer of the evidence. Just using compiled sources of evidence without understanding the issues that can affect the research results is not enough for physicians. If physicians don't understand the tools of critical appraisal of the medical literature, they will (naturally) tend to act on the evidence presented to them, regardless of the validity of that evidence. Validity could be reduced by bias in the study, manipulation of the study design (using placebo or "straw man" comparators rather than active drugs) and manipulating the statistical impact of the study. The last is done regularly using multiple outcome measures, composite outcomes or post hoc analysis of the data. If physicians don't understand these tools, they become the 'victims' of anyone who has any information to peddle. This could be the drug representatives or any other group wanting to make their agenda known and followed. The knowledge of how these factors affect the usefulness (applicabililty) of the results are what EBM is all about. I am looking forward to what the rest of the list has to add to this. Best wishes, Dan **************************************************************************** Dan Mayer, MD Professor of Emergency Medicine Albany Medical College 47 New Scotland Ave. Albany, NY, 12208 Ph; 518-262-6180 FAX; 518-262-5029 E-mail; [log in to unmask] **************************************************************************** >>> Martin Halperin <[log in to unmask]> 03/08/06 8:21 PM >>> I have been an observer of this listserv for a couple of months as I get acquainted with the main papers dealing with EBM. I am just starting a PhD which involves general practitioners use of online evidence resources, so the 'Best EBM methods papers' is extremely useful for me - thanks I don't know whether this listserv is used for much 'discussion', but I am interested to followup on what Steve was highlighting and ask for comments* Question: if research studies are biased to pharmaceutical interventions, and EBM relies on exploring the available evidence, then EBM will also be biased to pharmaceutical interventions. I know this is a bit simplistic, but is this true? Is there any solutions to counter this problem? Regards Martin Martin Halperin MBBS MPH Academic GP Registrar and Lecturer Department of General Practice Monash University 867 Centre Rd EAST BENTLEIGH Vic 3165 Phone: (03) 8575 2289 Fax: (03) 8575 2233 [log in to unmask] "Simon, Steve, PhD" <[log in to unmask]> wrote: > I looked through my files and found ten papers published in 2005 that > dealt directly or indirectly with EBM issues. I put these on my web > site. Look for the March 6, 2006 entry on my Research Methodology weblog > at: > > http://www.childrens-mercy.org/stats/weblog.asp > > Three papers merit special attention, because they call into question > the very research database that we rely on for EBM. > > 1. Medical journals are an extension of the marketing arm of > pharmaceutical companies. R. Smith. PLoS Med 2005: 2(5); e138 > 2. Contradicted and initially stronger effects in highly cited clinical > research. J. P. Ioannidis. Jama 2005: 294(2); 218-28. > 3. Randomized controlled trials of aprotinin in cardiac surgery: could > clinical equipoise have stopped the bleeding? D. Fergusson, K. C. Glass, > B. Hutton, S. Shapiro. Clin Trials 2005: 2(3); 218-29; discussion > 229-32. > > The first article in the list, by Richard Smith, is one among a large > series of articles that identify how commercial interests have made the > entire research endeavor open to question. The second article, by John > Ioannidis also calls the entire research endeavor into question and > points out the many factors that cause incorrect conclusions to be drawn > in most published research findings. The third article by Dean Fergusson > and others, argues that we do too much duplicative research that just > confirms what is already well established. The authors cite a particular > example involving placebo controlled trials which raises serious ethical > concerns, because 64 trials were run, but clear and convincing evidence > emerged by the time the 12th study was published. > > There are several other articles published in 2005 that corroborate the > problems cited by these three articles, but I could not easily locate > them. Sorry! > > You could argue that these are not truly EBM articles, but I believe > that they raise important issues that anyone who uses EBM should be > aware of. > > Steve Simon, [log in to unmask], Standard Disclaimer. > Look for my book "Statistical Evidence in Medical Trials" > which has just been published. For more details, see > http://www.childrens-mercy.org/stats/evidence.asp > > ----------------------------------------- CONFIDENTIALITY NOTICE: This email and any attachments may contain confidential information that is protected by law and is for the sole use of the individuals or entities to which it is addressed. If you are not the intended recipient, please notify the sender by replying to this email and destroying all copies of the communication and attachments. Further use, disclosure, copying, distribution of, or reliance upon the contents of this email and attachments is strictly prohibited. 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