BMJ  2008;336:1277 (7 June), doi:10.1136/bmj.a144

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Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? No

¹ University of California San Francisco, 3333 California Street, San Francisco, CA 94118, USA , ² San Francisco VA Medical Center, San Francisco, ³ Ottawa Health Research Institute, Ottawa, Canada

Analysis, doi: 10.1136/bmj.39569.510521.AD

Obtaining definitive evidence on the effects of large scale interventions can be difficult. Bernard Crump (doi: 10.1136/bmj.a145) believes that implementation with careful monitoring is justified but Seth Landefeld and colleagues argue that acting without proof is both costly and potentially damaging to health

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

Large scale healthcare interventions are likely to improve the health of the public if the evidence clearly shows that the benefits outweigh harms and costs. Often, however, the evidence is not compelling, and well intended interventions may fail to improve health, or may even cause harm, while costing dearly. Moreover, when a large scale intervention is implemented without compelling evidence, wishful thinking may replace careful evaluation, and an unproved innovation may become an enduring but possibly harmful standard of care. Such interventions should be implemented, therefore, only when the evidence shows that expected benefits outweigh harms and costs and only when the effects of implementation will be evaluated systematically.¹

Large scale healthcare interventions aim to influence clinical evaluation, treatment, or care of a large group of people. Some interventions are coercive, such as the restrictions on working hours for resident physicians enforced by the US Accreditation Council for Graduate Medical . . . [Full text of this article]

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