BMJ  2004;329:1012 (30 October), doi:10.1136/bmj.329.7473.1012

Paper

Half full or half empty VATS?

Peter McCulloch, reader in surgery1

1 Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU

Correspondence to: P McCulloch petermcculloch@doctors.org.uk

The first 150 words of the full text of this article appear below.

These paired studies on video assisted thoracic surgery (VATS) highlight a challenging question for proponents of evidence based medicine.1 2 After 10 years and, in this case, 12 randomised trials, why is practice so variable in specialties where the evidence seems clear? Is evidence based medicine, in fact, ineffective in changing clinical practice?

Disillusion is the child of overoptimism, and we should reflect that many influences for good remain of value despite less than universal adoption. Neither the United Nations nor the European Union has fulfilled all the ideals of their founders, but only their fanatical opponents would deny them some major achievements. Unsystematic review of recent medical progress makes a reasonably convincing case that evidence based medicine also has things to be proud of. Compared with 10 years ago, policy decisions in national health care in Europe and the United States are now informed much less by expert consensus conferences . . . [Full text of this article]


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