Intended for healthcare professionals

Feature Christmas 2013: Aggravations

Lack of evidence for clinical and health policy decisions

BMJ 2013; 347 doi: (Published 16 December 2013) Cite this as: BMJ 2013;347:f7155
  1. Sean R Tunis, president and CEO
  1. 1Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD 21202, USA
  1. Correspondence to: S R Tunis sean.tunis{at}
  • Accepted 11 November 2013

Sean Tunis has come up with a molecular biology based theory for the large amount of uncertainty in healthcare

A major frustration for clinical and health policy decision makers is the limited amount of relevant and credible evidence available to make evidence based decisions, a perspective conveyed in many health technology assessments and systematic reviews with some version of the following phrase: “Because of the paucity of high quality evidence, the data available—though voluminous—may have little meaning or value for informing clinical practice.”1 Many variations of this statement can be found, differentiated by subtle nuances of judgment reflected in the phrasing of the report’s executive summary—ranging from simple resignation to incredulity, exasperation, and hostility. This epidemic of ignorance is particularly perplexing given the fact that about 19 000 new randomized clinical trials are published each year, making one wonder how generating this amount of data while leaving so many gaps in knowledge is possible.

In seeking to understand this phenomenon, I …

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