BMJ  2006;333:807 (14 October), doi:10.1136/bmj.333.7572.807

Letter

Parachute approach to evidence based medicine

As obvious as ABC

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

EDITOR—I strongly oppose the proposition of Potts et al.¹ For all the difficulties of doing high quality randomised controlled trials of some research questions, or in challenging settings, making arbitrary decisions about the "obviousness" of the effectiveness of interventions based on observational evidence cannot be the way forward. This point is well made by the readers with expert knowledge who have already responded about the specific examples described by Potts et al.²

Other readers have criticised the naïveté of the argument but seem to accept the underlying sentiment that the world should not always wait for evidence from randomised controlled trials. This point of view presupposes some method, or criteria, for judging obviousness of effectiveness and merits further consideration.

Credit: PHOTOS.COM

 

I propose that deciding an intervention is obviously beneficial on the basis of non-randomised evidence requires benefit that clearly outweighs all possible adverse effects (whether frequent . . . [Full text of this article]

Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW barney.reeves@bristol.ac.uk

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