Evidence based vets

BMJ 2003; 327 doi: (Published 13 November 2003) Cite this as: BMJ 2003;327:1175
  1. Trisha Greenhalgh, professor of primary health care
  1. University College London

    This time last week, I was at the Royal Veterinary College running a workshop on evidence based medicine. I came with some credibility, since whoever prepared the chairman's brief had gleaned a story from this column of how I had once managed an obstetric emergency in a ewe.

    There's a bit of a crisis on. Most jobbing vets, I am told, make decisions on the basis of what worked on the last animal. Their journals and grand rounds are full of fascinomas such as patent ductus arteriosus in the badger or firework injury in a goldfish. Owners of companion animals (pets to you and me) increasingly download guff from the internet and demand jabs, magnetic resonance imaging, or antibiotics. The academics have begun to write guidelines, but the service clinicians don't follow them. Nobody does audit, and postgraduates on short courses want a quick update but turn off like a light when offered critical appraisal.

    My group of elite academics didn't miss a trick. Shown a paper on the treatment of osteoarthritis in dogs, they immediately raised questions about the provenance of the study (sponsored by a drug company with previous form for direct to consumer advertising), the sampling frame (overrepresentation of quirky breeds), compliance with medication (people might say they give their dogs the medicine, but what's the objective evidence that the tablets stayed down?), and the validity of the outcome measure (a high-tech trotting machine that purportedly quantifies the degree of limp in the cantering quadruped).

    A horse that had previously won a prestigious race (the name of the horse and the race were, of course, anonymised) now had a potentially career-threatening injury. A good “outcome” for the owner might not be in the best interests of the patient, which of course raised ethical problems that evidence based medicine could not solve. In any case, the paper on the performance of racehorses got short shrift. The researchers had made the elementary error of not controlling for the jockey.

    We concluded that animals deserve better evidence, and that more research is needed. As I walked to my car I mused that our commonalities are greater than our differences—until I discovered that one of their prize collection of birds of prey had crapped on my windscreen.

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