Evidence based medicine: does it make a difference?: Evidence base is weak and comes too late for evidence based policy making

doi:10.1136/bmj.330.7482.93-a

BMJ 2005;330:93 (8 January), doi:10.1136/bmj.330.7482.93-a

Letter

Evidence based medicine: does it make a difference?

Evidence base is weak and comes too late for evidence based policy making

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

EDITOR—Muir Gray says that evidence based policy makingis about taking decisions based on evidence and the needs andvalues of the population.¹ Surely one of the major barriersto better evidence based policy is that the evidence base isweak and too late.

In clinical practice, evidence in randomised controlled trialsoften uses selected groups of patients, excluding those withinconvenient comorbidities who would spoil the trial design.Yet these are the very patients who would benefit from the evidencebase. Therefore, when a general practitioner tries to explainthe risks and benefits of the options for managing atrial fibrillationto a patient with depression, the decision has to be made onsome trial, some knowledge of pharmocokinetics, and lots ofguesswork.

So it is with policy. How can we tell whether a policy willor will not work in a different time frame, environment, orcontext . . . [Full text of this article]

Tim Wilson, general practitioner

Mill Stream Surgery, Benson, Oxfordshire OX10 6RL Tim.wilson@gp-k84036.nhs.uk