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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…

Tobacco Plain Packaging: To Brand or Not To Brand

31 May, 16 | by BMJ Clinical Evidence

Felix Hernandez - croppedRahaghi - cropped

 

 

By Felix Hernandez and Franck Rahaghi

As we try to convince a patient to quit smoking after 60 years he quickly reminds us that in “his time” macho cowboys and cool camels advertised cigarettes on the television. With the many restrictions placed on tobacco advertising, the package has become the main vehicle for advertising. 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…

Better Decisions Require More Affordable Treatments: Part 2

25 May, 16 | by BMJ Clinical Evidence

Carl Heneghanby Carl Heneghan

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

Part 1 of this series pointed out we need better research to support better decisions. Market forces, though, may not be helping decision-making as new treatments – particularly drugs – are increasingly unaffordable and out of the reach of payers…

Estimates suggest the development of a newly approved drug currently costs around $2.6billion.  A high proportion of current costs are driven by high failure rates, the spiralling costs of clinical trials and competition with existing treatments that already have substantial effectiveness. As an example, Astra Zeneca’s five year drug development pipeline analysis reported only 2% of their products made it to market in this period: 59% of drugs completed Phase 1; only 15% completed Phase II, where most failures occurred and most improvement is required, and 60% completed Phase III. Whilst R&D costs have increased almost exponentially output has flatlined over the same time period. more…

Better Decisions Require Better Evidence: Part 1

25 May, 16 | by BMJ Clinical Evidence

Carl Heneghanby Carl Heneghan

The campaign starts at EvidenceLive 2016 – with  an open meeting to prioritise and explore the potential solutions to better evidence for better decisions.

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

At the core of evidence-based medicine is the integration of patient values and high quality evidence. Informed patients should also understand their treatment options and actively participate in making decisions about their own health, and  to achieve this, clinicians require better research evidence. However, there are growing concerns that a sizeable amount of current published research is irrelevant, wasteful and detrimental to patient care. more…

How to get published?

20 May, 16 | by BMJ Clinical Evidence

Trish_Groves_resizedDavid M_blog
By Trish Groves and David Moher

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….

The highlight of last year’s excellent Evidence Live was, for me (Trish Groves), a short, private conversation. Two doctors from Pakistan (a husband and wife) sought me out to say they had taken part in my Evidence Live workshop two years earlier, on how to publish research. They went on to complete their research and, for the first time, to successfully publish two papers. “BMJ helped us broaden our vision, and changed our lives” they said.

Similar stories, and a growing realisation that we all need to tackle the huge challenge of waste in research, inspired BMJ to develop Research to PublicationThis is a comprehensive eLearning programme for early career researchers. more…

Living Systematic Reviews: towards real-time evidence for health-care decision-making

12 May, 16 | by BMJ Clinical Evidence

Mavergames 150x150Elliott_150x150

 

By Chris Mavergames and Julian Elliott

Systematic reviews aim to provide an accurate summary of available evidence for specific health questions. In practice, an increase in methodological expectations and an increasing deluge of primary studies challenges the ability of many review teams to produce timely, high quality systematic reviews and to keep them up to date. Only a minority of reviews are updated within 2 years and as new research is published in the intervening period, these delays lead to significant inaccuracy. One estimate is that 7% of systematic reviews are inaccurate the day they are published and after two years 23% of reviews that are not updated will present incorrect conclusions.  The difficulties faced by review teams in keeping reviews up to date leads to considerable inaccuracy and to some extent undermines the value created through the use of rigorous methods. more…

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