On 12/04/12 14:10, Anoop Balachandran wrote:
> Hi Neil,
> If I get it right, it is the "best research available".So if there are no
> systematic reviews, you just go down the levels of evidence and pick the
> next best one RCT, Observational study and so forth. But as you go down the
> levels, the uncertainity goes up too.
I wouldn't be so rigid: there are cases when a single RCT may be better
than a SR (for example, a large RCT conducted in a setting similar to
the one where the clinical encounter occurs, compared to a SR of
smaller/more disparate studies.
As my father used to say "a good bier is better than a bad wine" (seen
from the perspective of an Italian culture ;-)
In this case, what is "best" depend on the relevance to the problem at
hand, rather than just on the study design. And of course "best" implies
that all the available evidence has been evaluated.
As for the general question, I think that definitions are more
problematic than useful. Descriptions are much more useful to
communicate human concepts, and I still think that the original
description by Dave Sackett is the one that more closely reflects my
(attempts of) practice, if you just extend the meaning of "medicine" to
include all the aspects of medical/heath care, beyond the medical
profession. The debate about medicine/practice/healthcare/etc seems to
me to be more about the wars between the ivory towers of different
professions than about the matter itself (i.e. patient care).
And of course there may be more than one way to describe the same
concept, as well as somewhat different ways of practice sharing the same