Intended for healthcare professionals


Confronting therapeutic ignorance

BMJ 2008; 337 doi: (Published 16 July 2008) Cite this as: BMJ 2008;337:a841
  1. Iain Chalmers, coordinator
  1. 1James Lind Initiative, Summertown Pavilion, Oxford OX2 7LG
  1. ichalmers{at}

    Tackling uncertainties about the effects of treatments will help to protect patients

    This week’s BMJ includes the first of a series of articles on areas of practice where clear and robust evidence is lacking, and where uncertainty exists about management.1

    Our failure to confront uncertainty about the effects of treatment has resulted in the suffering and death of patients, sometimes on a massive scale. Hundreds of thousands of people died prematurely because of failure to tackle uncertainty about the effects on mortality of prophylactic use of antiarrhythmic drugs in myocardial infarction.2 3 When the CRASH trial assessed uncertainty about the effects of corticosteroids in acute traumatic brain injury, it revealed that this treatment had been killing people for more than three decades.4 5 When widespread uncertainties about the effects of caffeine used to reduce episodes of apnoea in premature babies were assessed more than 30 years after the treatment had been introduced, it turned out that this simple treatment reduces …

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