Since the early 1970s and the seminal work of Archie Cohrane ¹, modern medicine has pursued, promoted and prized evidence based medicine, but perhaps lost sight of their responsibilities and the challenges in producing it.
In order to secure a constant flow of evidenced based medicine to inform ourselves, we must insist on the highest quality of informed research and not be tempted by the low hanging fruit of repetitious, quick, cheaper or poorly designed studies.
Research time is a precious resource and it is saddening to see that research within the field was uniformed, diffuse and of poor quality following Picard’s meta-analysis. How many research hours and resources were wasted in those studies? What pressing questions could be answered if those hours had been correctly invested?
It’s not only study design but implementation that can crumble without strict control. I'm reminded of the EVOLVE study² , in which one third of the placebo group were withdrawn and started on the active treatment during the protocol. Millions of research dollars and a wasted opportunity. How easily evidence based medicine is hoist on its own petard.
I wonder would evidence medicine as a whole, benefit from a tighter control of research, via a centralised governing body to act as a decision making “brain.” This central system could synthesise all available data create only the most viable and well-designed trials and research. Cost savings, removal of redundancy, and providing higher quality research and answers are goals worth pursuing in my opinion. While individual and institutions would bemoan the loss of independence , we have data from this study now, just suggest that the scientific community as it currently functions is in need of more focus.
1. (1972) C AL. Effectiveness and efficiency: random reflections on health services. London R Soc Med Press.
2. Chertow GM, Block GA, Correa-Rotter R, et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367(26):2482-94. doi:10.1056/NEJMoa1205624.
Rapid Response:
Since the early 1970s and the seminal work of Archie Cohrane ¹, modern medicine has pursued, promoted and prized evidence based medicine, but perhaps lost sight of their responsibilities and the challenges in producing it.
In order to secure a constant flow of evidenced based medicine to inform ourselves, we must insist on the highest quality of informed research and not be tempted by the low hanging fruit of repetitious, quick, cheaper or poorly designed studies.
Research time is a precious resource and it is saddening to see that research within the field was uniformed, diffuse and of poor quality following Picard’s meta-analysis. How many research hours and resources were wasted in those studies? What pressing questions could be answered if those hours had been correctly invested?
It’s not only study design but implementation that can crumble without strict control. I'm reminded of the EVOLVE study² , in which one third of the placebo group were withdrawn and started on the active treatment during the protocol. Millions of research dollars and a wasted opportunity. How easily evidence based medicine is hoist on its own petard.
I wonder would evidence medicine as a whole, benefit from a tighter control of research, via a centralised governing body to act as a decision making “brain.” This central system could synthesise all available data create only the most viable and well-designed trials and research. Cost savings, removal of redundancy, and providing higher quality research and answers are goals worth pursuing in my opinion. While individual and institutions would bemoan the loss of independence , we have data from this study now, just suggest that the scientific community as it currently functions is in need of more focus.
1. (1972) C AL. Effectiveness and efficiency: random reflections on health services. London R Soc Med Press.
2. Chertow GM, Block GA, Correa-Rotter R, et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367(26):2482-94. doi:10.1056/NEJMoa1205624.
Competing interests: No competing interests