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Autism Interventions: Ask for the Evidence

5 May, 16 | by BMJ Clinical Evidence

Michael Fitzpatrick_2_cropBy Michael Fitzpatrick

“There’s so many cures for autism on-line, it’s a wonder anyone still has it”

This wry observation from the father of a five-year-old newly diagnosed with autism in the BBC’s ‘The A Word’ strikes a chord with every parent who has been through this experience. As a GP with an autistic son – now 23 –  I have seen wonder cures, from secretin and facilitated communication to chelation and hyperbaric oxygen therapy, appear and disappear at a bewildering pace over the past two decades.  An internet survey in the USA found parents were using 111 different treatments, including diverse speech and behaviour therapies, medications, diets, vitamins and supplements – on average using seven such ‘interventions’ concurrently.
Given that no specific intervention – beyond behavioural educational programmes – has been shown to be beneficial for children with autism, the vast variety of treatments on offer puts parents who are struggling to cope with the challenges of autism in a difficult position. In the spirit of ‘Ask for the Evidence’, I suggest three simple questions:

more…

Meningitis: can we afford not to vaccinate?

25 Apr, 16 | by BMJ Clinical Evidence

BKampmannBy Beate Kampmann

As I complete my ward round in a London Teaching Hospital with a visit to the 7 year old boy who has already lost both lower limbs due to meningococcal disease and who is staring at his black, necrotic fingers, I remind myself that this child was actually vaccinated as a baby with a vaccine against Meningococcus Type C (MenC). more…

Policy, practice, and politics

21 Apr, 16 | by BMJ Clinical Evidence

Van photoBy Van Charles Lansingh

In the advent of the Zika scare, it is clear that the need for evidence and sensationalism are difficult to balance, and due to the pressure from the media, many governments and various entities, responded in haste and with probably very little time to analyze their recommendations. A similar case was seen in the wake of the Ebola outbreak. The global community has seen and experienced the consequences: fear and confusion of managing and controlling a disease that has limited evidence and knowledge base, and lack of historical antecedents to support the actions taken.

However, we often do have the evidence more or less readily available to respond to the health information needs and to the requests from policy makers. Unfortunately, more often than not, this information is too complex and difficult to determine what is correct and what is simply popular belief. The plethora of publications makes it difficult to sift through and summarize, so that there is an adequate process of translation from evidence generated by researchers, to policy and practice. more…

The blind leading the blind in the land of risk communication

14 Apr, 16 | by BMJ Clinical Evidence

 

Glyn ElwynBy Glyn Elwyn

It is often said that humans are terrible at understanding risk. Maybe so when it comes to ratios and rates – abstract forms of data. But all of us navigate the world by moving, walking or driving – constantly comparing distances, magnitudes and likelihoods, making estimates about the risk of collisions, repeatedly, and accurately. We are actually risk calculators extraordinaire – and we do it all effortlessly, using heuristics, and get it right, most of the time. Our survival depends on it.

Blind leading the blindBut when it comes to health care – we are less confident. When to start a medication? When to have an operation or a test? Plus, we have much less experience to draw on. And less data. Often, no data at all. more…

Culture, evidence and implementation

7 Apr, 16 | by BMJ Clinical Evidence

James Cave croppedBy James A. H. Cave

Over two decades ago I joined a practice in the rolling Berkshire Downs. As a young thrusting, straight-out-of-VTS GP I was keen to do a new activity called “an audit”. This was a completely new thing to my partners and it took some explaining to them why it might be useful. “But I always check the electrolytes on my patients on an ACEI “ the senior partner replied when I suggested we could audit this, “you’ll just be wasting your time”. more…

The PrEP debate gains momentum

29 Mar, 16 | by BMJ Clinical Evidence


Mags Portman_imageBy Mags Portman

This week has seen a landmark shift in the pre-exposure prophylaxis for HIV (PrEP) debate in England. Following 18 months of work with key stakeholders, including clinicians, commissioners and community advocates, NHS England (NHSE) announced that it was no longer able to fund a significant PrEP rollout; the outcome the Clinical Reference Group (CRG) thought that they had been working towards. The rationale given for this late stage decision is that NHSE do not commission HIV prevention. NHSE will be making available up to £2m over the next two years to run a number of early implementer test sites. Local authorities have to bid to become an early implementer test site.

Truvada for use as pre-exposure prophylaxis for HIV (PrEP) was licensed for use in the United States in July 2012. There is evidence from San Francisco that a combination HIV prevention approach with PrEP, Treatment as Prevention plus condoms and behavioural intervention is having an impact upon HIV incidence. more…

The Rise of Rapid Reviews

24 Mar, 16 | by BMJ Clinical Evidence

JRB profile picture v2By Jon Brassey

“Perfect is the enemy of good” Voltaire

Rapid reviews are becoming increasingly commissioned, used and written about. But why is there this, relatively sudden, interest? Putting it bluntly, it’s because the cornerstone of evidence synthesis, the systematic review, is becoming increasingly out of touch with the needs of today’s healthcare systems.

The journal Systematic Reviews recently featured an editorial ‘All in the Family: systematic reviews, rapid reviews, scoping reviews, realist reviews, and more’. In the article they report “It is our view that all of these new forms of reviews are related to systematic reviews, similar to the way that different biological Species within the same Family are related to each other.” Tantalisingly they later raise the issue of the extinction of some methods. Is it a given that systematic reviews, as we know them, deserve to survive? more…

Still no evidence for homeopathy

10 Mar, 16 | by BMJ Clinical Evidence

Paul GlasziouBy Paul Glasziou

This blog was originally written for thebmj and posted on bmj.com/blogs

 

When the National Health and Medical Research Council report on homeopathy concluded that “There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered” few in conventional medicine were surprised, but the homeopathy community were outraged. As chair of the working party which produced the report I was simply relieved that the arduous journey of sifting and synthesising the evidence was at an end. I had begun the journey with an “I don’t know” attitude, curious about whether this unlikely treatment could ever work. Still, who would have believed that bacteria caused peptic ulcers, or that vaccines for cancers would become routine. So just maybe.…but I lost interest after looking at the 57 systematic reviews (on 68 conditions) which contained 176 individual studies and finding no discernible convincing effects beyond placebo. more…

What does Evidence-based actually mean? or Where have all the sceptics gone?

25 Feb, 16 | by BMJ Clinical Evidence

Caroline Blaine

By Caroline Blaine

Commonly held opinions of Evidence-Based Medicine (EBM) include:

“Surely all medicine practised today is evidence-based.”

OR

“EBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not “fit” the patient in front of me.”

Neither of these assumptions is true. The first one denies—against all evidence—that a problem exists, and the second is far from what the founders of EBM described.

Looking back to the publications on EBM from the early 1990’s onwards gives a perspective of the serious issues they were tackling, and the desire to make this fun, as well as easy to understand and adopt. Re-reading the original papers, it is disappointing to reflect on how little the paradigm has shifted. more…

How systematic reviews can reduce waste in research

11 Feb, 16 | by BMJ Clinical Evidence

Paul Glasziou

Iain ChalmersBy Paul Glasziou and Iain Chalmers

This blog was originally written for thebmj and posted on bmj.com/blogs

 

If you asked a member of the public “Should researchers review relevant, existing research systematically before embarking on further research?” they would probably be puzzled. Why would you ask a question with such an obvious answer? But in the current research system, researchers are only rarely required by research funders and regulators to do this. more…

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