Intended for healthcare professionals

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Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? Yes

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1276
  1. Bernard Crump, chief executive officer
  1. 1NHS Institute for Innovation and Improvement, Coventry CV4 7AL
  1. bernard.crump{at}

Obtaining definitive evidence on the effects of large scale interventions can be difficult. Bernard Crump believes that implementation with careful monitoring is justified but Seth Landefeld and colleagues (doi: 10.1136/bmj.a144) argue that acting without proof of net benefit is both costly and potentially damaging to health

Large scale health intervention covers a wide range of circumstances, including the use of a new drug or therapeutic procedure. In this case we have developed over the past 50 years a widely accepted understanding of the nature of the evidence that would lead to a consensus about an intervention’s use, while not underestimating the challenge of acquiring it. Other interventions are much more complex; they are about the behaviour of people and systems, and it does no service to the public to apply only the yardsticks we have developed for narrower biomedical interventions. Although we should be equally rigorous in our evaluation, we need to learn from other scientific sectors to broaden our understanding of evidence.

Imperfect evidence

In the NHS the National Institute for Health and …

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