BMJ  2008;336:1276 (7 June), doi:10.1136/bmj.a145

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Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? Yes

¹ NHS Institute for Innovation and Improvement, Coventry CV4 7AL

Analysis, doi: 10.1136/bmj.39569.510521.AD

Obtaining definitive evidence on the effects of large scale interventions can be difficult. Bernard Crump believes that implementation with careful monitoring is justified but Seth Landefeld and colleagues (doi: 10.1136/bmj.a144) argue that acting without proof of net benefit is both costly and potentially damaging to health

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

Large scale health intervention covers a wide range of circumstances, including the use of a new drug or therapeutic procedure. In this case we have developed over the past 50 years a widely accepted understanding of the nature of the evidence that would lead to a consensus about an intervention’s use, while not underestimating the challenge of acquiring it. Other interventions are much more complex; they are about the behaviour of people and systems, and it does no service to the public to apply only the yardsticks we have developed for narrower biomedical interventions. Although we should be equally rigorous in our evaluation, we need to learn from other scientific sectors to broaden our understanding of evidence.

In the NHS the National Institute for Health and Clinical Excellence (NICE) gives guidance on questions such as "Should the NHS make available gemcitabine for pancreatic cancer?" or "Is there adequate information about . . . [Full text of this article]

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