BMJ 1995;311:257-258 (22 July)

Letters

Many questions cannot be answered by evidence based medicine

EDITOR,--We envisage that databases for evidence based medicine would answer the question "What is best practice?" and that hospital based audit would check that best practice is being achieved. Our audit programme has examined pain relief for tonsillectomy. In the 58 children audited, nine tonsillar blocks were performed; additional oral pain relief was required earlier in these nine children than in the children who had alternative intraoperative analgesia (n=9) (3.3 h v 7.6 h).

A conflict therefore arises over whether we should persist with tonsillar block and improve our performance even though we know that some children will be in pain while we are improving or whether we should abandon it for the method that gives better analgesia in our hands. We would now have difficulty in gaining the approval of an ethical committee for a trial of tonsillar block, so such a trial would not be included in an . . . [Full text of this article]


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Relevant Article

Evidence based medicine
Frank Davidoff, Brian Haynes, Dave Sackett, and Richard Smith
BMJ 1995 310: 1085-1086. [Extract] [Full Text]

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