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Evidence Live

The importance of getting evidence into health service decision making, even where there is uncertainty

22 Jun, 16 | by BMJ Clinical Evidence

DT

By David Tovey

Earlier this week I attended the launch of a Kings Fund paper in the rarefied setting of Portcullis House, an annex of the Palace of Westminster. The subject was “Bringing together physical and mental health: A new frontier for integrated care”. A panel that included Presidents of the Royal Colleges of Physicians and Psychiatrists, was chaired by a member of the House of Lords. The diagnosis was an important and topical one: care for people with long term physical conditions is insufficiently holistic and frequently omits psychological effects.  The mirror image is also true, perhaps with even more serious consequences: people with long term mental illness suffer and die as a consequence of inadequate physical care. So, unmet need in both scenarios and a stimulating basis on which to construct my Evidence Live 2016 presentation on the subject of “Translating Evidence into Better Quality Health Services”.

What is the appropriate response? In passing, I can’t help but notice that until very recently, it would have been inconceivable that such a meeting would not include at its centre, the crucial role of general practice or primary care. Yet, on this occasion, neither rated more than a passing reference, and the Royal College of General Practitioners was conspicuously absent. That seemed a problem – both for the NHS and for primary care itself. What about evidence? It would not be true to say that evidence was completely absent, but it was not central to the discussion that followed the presentations, and it ranked a long way behind “an increase in resourcing” in terms of its visibility as a potential solution. more…

Beware evidence “spin”: an important source of bias in the reporting of clinical research

21 Jun, 16 | by BMJ Clinical Evidence

Kamal R Mahtani

 

By Kamal R Mahtani

Spin [WITH OBJECT] Draw out and twist (the fibres of wool, cotton, or other material) to convert them into yarn, either by hand or with machinery: “they spin wool into the yarn for weaving”

 

Does the name Malcolm Tucker ring a bell? The Malcolm Tucker I am referring to is the fictional character from the BBC political satire The Thick of it. Tucker (played by Peter Capaldi) was a government director of communications, skilled in propaganda, more specifically in the art of “spinning” unfavorable information into a more complimentary, approving (and sometimes even glowing) public facing message. Whether the show accurately reflects real life governmental politics, or whether real life politicians ‘copy’ the show, remains a topic of discussion. Either way, “spin” in the political arena feels like something we are increasingly getting used to, almost expect.

 

“Spin” in reports of clinical research

For many researchers, the number of publications, and the impact of those publications, is the usual currency for measuring professional worth. Furthermore, we are increasingly seeing researchers discuss their work in public through mainstream and social media, as more of these opportunities arise. With this in mind it probably won’t come as such a shock to imagine that researchers might be tempted to report their results in a more favorable (again, even glowing) way than they deserve i.e. to add some “spin. more…

Too many drugs, too few medicines! The translational failure of animal research

20 Jun, 16 | by BMJ Clinical Evidence

Emily SenaBy Emily Sena

374 interventions have been reported to be effective in experimental stroke; 97 were tested in clinical trials but only one of these was shown to be effective. The principle of drug development goes that if a therapy improves outcome in animals the next step is to test it in humans in a clinical trial, with the hope that important improvements in outcome will be seen. The reality is that there are huge amounts of animal data (too many drugs), from experiments that are not designed with sufficient rigour or adequately reported, and important improvements in outcomes are usually not seen in clinical trials (too few medicines).  Many animal experiments are failing in their objective effectively to inform human health.

And there are a lot of drugs around – in 2013, 350 publications describing animal experiments were published every day! I understand that the average life scientist has neither the desire nor the need to consume this amount of information, but even within a limited research domain relevant data accumulate rapidly. In an endeavour where future ideas, decisions and directions are based on our existing knowledge it is important that we are able to identify, critique and synthesise data in an unbiased, timely and useful manner. more…

Too much medicine – Prescription drugs are the third leading cause of death

16 Jun, 16 | by BMJ Clinical Evidence

Peter GotzscheBy Peter C Gøtzsche

Our prescription drugs are the third leading cause of death after heart disease and cancer.[1] Based on the best research I could find, I have estimated that psychiatric drugs alone are also the third major killer,[2] mainly because antidepressants kill many elderly people through falls.[3] This tells us that the system we have for researching, approving, marketing and using drugs is totally broken. [1][2]

What makes this tragedy particularly absurd is that the vast majority of the deaths can easily be prevented. Non-steroidal, anti-inflammatory drugs (NSAIDs) carry a huge death toll, primarily by causing bleeding stomach ulcers and myocardial infarction, and most of those who die could have done well without drugs or by taking paracetamol. The idea that NSAIDs have an anti-inflammatory effect has been disproven by placebo controlled studies.[4][5] more…

Threats to traditional systematic reviews

15 Jun, 16 | by BMJ Clinical Evidence

JRB profile picture v2By Jon Brassey

For many years systematic reviews have been placed on a pedestal, relatively free from critical scrutiny. Frequently seen as being at the top of the ‘evidence pyramid’ they have been adopted as the main way of assessing the worth of an individual intervention.

More recently threats to the pre-eminence of systematic reviews have come from multiple areas. Some authors, including myself, have been critical of groups such as Cochrane for creating methods that are so costly in terms of finance and time that too few are done and the majority are not being kept up to date. more…

Transforming the Communication of Evidence for Better Health

14 Jun, 16 | by BMJ Clinical Evidence

MontoriBy Victor Montori

The main job is to care for the patient. Evidence-based medicine makes use of an adjectival phrase, evidence-based, to note that this is a form of special medical practice, but still it is medicine, it is care. The adjective that modifies this noun, and the verb – to care — it implies, signals the importance of considering the scientific basis of our practice, and the need to use evidence judiciously in the care of patients. This was an important development, maturing in early 90s when the idea and the term, coined by Gordon Guyatt, came into use. The term, and the practice, influenced my late medical training, and have been fundamental in my first two decades at the honorable place of the patient’s bedside.

In some instances, the adjective “evidence-based” took precedence over the noun, and the practice of medicine, the care of the patient, became relegated. The limelight shone on the significant result in a mega trial, an effect on a surrogate or a composite, in a trial stopped earlier than planned, and financed by the company that will profit by using these results in marketing its product. These marketing efforts disguised as evidence-based messages, actively disseminated by those who hold the power of telling us what to know. In 2007, we published with Gordon Guyatt how the corruption of the evidence threatened the practice of EBM and suggested several solutions: more…

Whither Evidence in the Social Media World?

9 Jun, 16 | by BMJ Clinical Evidence

EL SM2

 

By Douglas Badenoch and André Tomlin

The tired old trope of “my evidence” vs “your evidence” is endlessly rehearsed on the social media discussions and comments sections.  Powerful groups – both corporate and voluntary – deploy effective media strategies to undermine scientific claims that run counter to their interests. And now personalisation of social media means that we exist in a “filter bubble” in which we never see things we don’t already like.  “Intellectual pudding”, when what we need is “vegetables”.  In an era of clickbait, trolling and sockpuppets, what chance does good quality evidence stand? more…

Promoting informed healthcare choices by helping people assess treatment claims

27 May, 16 | by BMJ Clinical Evidence

Informed choices

 

by Iain Chalmers, Paul Glasziou, Douglas Badenoch, Patricia Atkinson, Astrid Austvoll-Dahlgren and Andy Oxman

In the run up to Evidence Live 2016, we are running a series of blogs by the speakers at the conference discussing what they will be speaking about at the conference….

All of us are bombarded by treatment claims. These reach us through the media, from people selling treatments, from academics, from health professionals, and from relatives, friends and people we happen to bump into.

How should people making health choices assess the trustworthiness of such claimed effects of treatments? In particular, how should research evidence play into our assessment of these treatment claims – whether for treatments for something as trivial as a cold, or as life threatening as cancer, or anything in between? Whatever the issue, those making treatment choices have the greatest vested interest in knowing how to go about assessing claims about the effects of treatments because it is they who stand to lose or benefit from the choices they make. more…

Better Decisions Require Research that Matters: Part 4

25 May, 16 | by BMJ Clinical Evidence

Carl Heneghan

 

by Carl Heneghan

This blog was originally written for Evidence Live blogs and posted on evidencelive.org

 

 

Poor quality evidence, lack of affordability and uninformed patients suggest an awful lot of research doesn’t actually matter. However, for informing better decisions when presented with a piece of evidence there are three questions that I use to identify and weed out most research that doesn’t matter: 1) does this research apply to my patient; 2) is the research of sufficient length to inform the outcome given the clinical course of the disease, and 3) will this evidence make a difference to my patient’s outcome? more…

Better Decisions Require Better Informed Patients: Part 3

25 May, 16 | by BMJ Clinical Evidence

Carl Heneghan

 

by Carl Heneghan

This blog was originally written for Evidence Live blogs and posted on evidencelive.org

 

 

The first two articles in this series pointed out we need better and more affordable evidence. Yet, even if affordable high quality evidence is forthcoming it is imperative that patients can make informed decisions and that doctors have the tools to actually inform patients it in practice.

There is, however, growing unease that the current system is not serving patients information needs. Sally Davies, the UK’s Chief Medical Officer (CMO), recently requested a review to restore public trust in the safety and effectiveness of medicines, because patients increasingly see doctors as over-medicating and clinical scientists who are afflicted by conflicts of interest: the CMO therefore considers it is difficult for the public to trust either. more…

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