Dear colleagues,
Several months ago I attempted to perform a survey regarding the
issue so often discussed among the members of this discussion group. That
is, among hundred of thousands of the trials that we so far performed, can
we actually identify those great ones that have had the major impact on
medical practice. Many people responded to a survey-some with a concrete
examples and some with general comments or thoughts regarding this
initiative. I thank them all, and hope they will continue to contribute to
future modifications and update of the list.
Undoubtedly, this is enormous and ambitious task and a survey such
as this cannot come even close to identify all evidence that has been
accumulated over years and that changed our practice. Yet, the issue will
not go away, and will likely will be asked more forcefully in years to come.
So, as imperfect as it may be, here is a list of the trials which in opinion
of some members of this group could qualify as EVIDENCE THAT CHANGED OUR
PRACTICE. To review it, please go to
http://www.hsc.usf.edu/~bdjulbeg/oncology/practice-change.htm
You will notice there are actually two lists (1. RCT that changed
the practice, 2.Non-RCT that changed our practice). Of interest is that a
list of Non-RCT with the major impact on medical practice is much shorter.
Could it be that is because breakthroughs in medicine are so rare, and that
most of advances in therapeutics can only come from a rigorous empirical
testing in RCTs? Perhaps the lists provided here can further contribute to
this key, albeit admittedly a combative issue- where should resources be
allocated: to basic science research vs. clinical research (so called, NIH
vs. Cochrane model).
I am hoping that exposing these lists to open discourse, over time,
perhaps we may actually compile the COMPLETE and universally ACCEPTED list
of all trials that changed clinical practice.
I would appreciate any further thoughts and contribution to this
initiative. Thanks.
ben djulbegovic
Benjamin Djulbegovic, MD,PhD
Associate Professor of Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Division of Blood and Bone Marrow Transplant
12902 Magnolia Drive
Tampa, FL 33612
Editor: Evidence-based Oncology
http://www.harcourt-international.com/journals/ebon/
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
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