ABC series may be anachronistic in era of evidence based medicineBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7061.880 (Published 05 October 1996) Cite this as: BMJ 1996;313:880
- C B Del Mar, Professor,
- Paul P Glasziou, Senior lecturer
EDITOR,—Are the ABC series now an anachronism? As the medical profession moves into the era of evidence based medicine, what is the place of articles that do not distinguish evidence (or the lack of it) from personal prejudice (in its original sense of “prejudged”)?
In their article on prostate cancer in the ABC of Urology, Chris Dawson and Hugh Whitfield begin with the uncertainties and inadequacies of the options for screening for prostate cancer.1 They then suggest that the key is to find a test that can differentiate between those cancers that are indolent and those that are going to be clinically important. Without substantiation they say that measurement of prostate specific antigen may be able to do this and therefore may be valuable as a screening tool.
We do not agree. The question is even more fundamental: what evidence is there that any treatment of prostate cancer offers increased survival? Until there is evidence of benefit it may be legitimate to ask whether any treatment other than symptomatic treatment is justified, let alone whether we should be treating people who are asymptomatic.
To return to our initial question, we wonder how continuing medical education articles should look in an era of evidence based medicine. Can busy clinicians overcome the time constraints to work out their own management policies from original data? If not, the job of articles such as this is to synthesise the data in as palatable a manner as possible to allow clinicians to use them to offer the best possible care. We need to know what is established in the literature with good evidence, what is best practice in its absence, and what is the author's personal but possibly idiosyncratic choice—that is, the quality of the information must be labelled.2 3