Individuals, averages, and evidence based medicine

doi:10.1136/bmj.a2585

Published 19 November 2008, doi:10.1136/bmj.a2585
Cite this as: BMJ 2008;337:a2585

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Does this work for you?

Individuals, averages, and evidence based medicine

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

In asking "Does this work for you?"¹ Christakis finds the heartof evidence based medicine—"the conscientious, explicitand judicious use of current best evidence in making decisionsabout the care of individual patients."² The individual approachcan also reconcile clinical trial results with the demands ofclinical practice: "managers and trialists may be happy fortreatments to work on average; patients expect their doctorsto do better than that."³

That not all patients achieve great benefit and need an individualisedapproach has been shown in treating depression⁴ and is particularlytrue for pain.

In acute pain, patients either have very good or very poor painrelief with non-steroidal anti-inflammatory drugs. In neuropathicpain fewer than half of patients commonly achieve adequate painrelief with any treatment. In migraine the proportion of patientsachieving rapid and prolonged pain relief (adjusted for theplacebo response) is only about 25%. With TNF-antagonists in. . . [Full text of this article]

Andrew Moore, senior research fellow¹, Sebastian Straube, academic foundation year 2 doctor¹, Sheena Derry, research associate¹, Henry McQuay, Nuffield professor of clinical anaesthetics¹

¹ Pain Research and Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU

andrew.moore@pru.ox.ac.uk

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