Comprehensive evidence is needed in decision making

EDITOR—Davey Smith et al have identified some problems with evidence based decision making in health care.1 Nevertheless, when these are set against the deficiencies of much current (non-evidence based) decision making, evidence based decision making still compares favourably.

Administrators, facing complex allocation choices within tight budgets, are inclined to focus on economic notions of efficiency and fair play. The rationale is: “If it's not too expensive and seems to help a disadvantaged group we might be prepared to pay for it.” When people are presented with a problem (often the solution is presented first, implying that there must be a problem) they gather whatever information will confirm the merit of the intended intervention as quickly as possible. Inequalities in health are not remedied, nor …