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

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.a144 (Published 05 June 2008) Cite this as: BMJ 2008;336:1277
  1. C Seth Landefeld, professor12,
  2. Kaveh G Shojania, assistant professor3,
  3. Andrew D Auerbach, associate professor of medicine1
  1. 1University of California San Francisco, 3333 California Street, San Francisco, CA 94118, USA
  2. 2San Francisco VA Medical Center, San Francisco
  3. 3Ottawa Health Research Institute, Ottawa, Canada
  1. Correspondence to: C S Landefeld [email protected]

    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

    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, …

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