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Aspirin prophylaxis for vascular disease

BMJ 1998; 317 doi: (Published 07 November 1998) Cite this as: BMJ 1998;317:1318

Knowledge needs to be used in clinical situations

  1. D Fitzmaurice, Senior lecturer,
  2. C P Thomas, Senior lecturer
  1. Department of General Practice, Medical School, University of Birmingham, Birmingham B15 2TT
  2. Department of Surgery, Withington Hospital, Manchester M20 8LR
  3. Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle NE2 4AA
  4. Centre for Health Economics, University of York, YO1 5DD

    EDITOR—We read with interest the recent articles from the North of England evidence based guideline development project. 12We represent the Birmingham Clinical Effectiveness Group and admire the rigour with which these guidelines have been developed. The effort required to synthesise this amount of evidence cannot be underestimated, but has the effort been worth while?

    None of the guidelines provides new evidence, and, given the basic requirement for evidence based medicine to answer a clinically relevant question, their value is questionable. For example, it is well known that aspirin after myocardial infarction is beneficial.3 The challenge lies in increasing the use of aspirin in this clinical situation, in changing behaviour rather than simply improving knowledge. We wonder whether these guidelines will effect change such that aspirin use is increased. Similarly, it has been recognised for some time that the use of angiotensin converting enzyme inhibitors is beneficial for patients with cardiac failure, and the challenge remains the same.

    Maybe the effort and funding expended in reinforcing what …

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