Freeman and Sweeney’s study [1] seems to share the underlying
assumption of so much that is written on this subject, that evidence is
clear-cut and the only problem is getting practitioners to put it into
practice. My perception of evidence, however, is that it is often slippery
stuff - at best frequently changing and at worst contradictory and
confusing - and that best evidence is often not very good. Part of the
problem is therefore deciding exactly what to put into practice.
The findings and interpretation of individual papers, systematic
reviews, meta-analyses, and reviews of systematic reviews and meta-
analyses, are regularly debated in your columns. Anticoagulation was one
of the clinical areas discussed by the participants in Freeman and
Sweeney’s study, but stroke prevention in atrial fibrillation is a
controversial subject. How many general practitioners who have read the
papers on atrial fibrillation in the BMJ over the last couple of years,
and subsequent correspondence [e.g. 2], feel confident about the
conclusions to be drawn from this evidence as to which of their patients
would be best treated with warfarin and which with aspirin? “Clinical
Evidence”[3]helps, but can we be sure that its authors are more objective
than the combatants in your correspondence columns?
The fickleness of evidence is very inconvenient, but would be easier
to live with if it was more widely acknowledged in discussion of
implementation.
1. Freeman AC, Sweeney K. Why general practitioners do not implement
evidence: qualitative study. BMJ 2001; 323: 1100-1102.
2. Cleland et al. Long term anticoagulation or antiplatelet
treatment. BMJ 2001; 323: 233-236.
Rapid Response:
Evidence is slippery stuff
Freeman and Sweeney’s study [1] seems to share the underlying
assumption of so much that is written on this subject, that evidence is
clear-cut and the only problem is getting practitioners to put it into
practice. My perception of evidence, however, is that it is often slippery
stuff - at best frequently changing and at worst contradictory and
confusing - and that best evidence is often not very good. Part of the
problem is therefore deciding exactly what to put into practice.
The findings and interpretation of individual papers, systematic
reviews, meta-analyses, and reviews of systematic reviews and meta-
analyses, are regularly debated in your columns. Anticoagulation was one
of the clinical areas discussed by the participants in Freeman and
Sweeney’s study, but stroke prevention in atrial fibrillation is a
controversial subject. How many general practitioners who have read the
papers on atrial fibrillation in the BMJ over the last couple of years,
and subsequent correspondence [e.g. 2], feel confident about the
conclusions to be drawn from this evidence as to which of their patients
would be best treated with warfarin and which with aspirin? “Clinical
Evidence”[3]helps, but can we be sure that its authors are more objective
than the combatants in your correspondence columns?
The fickleness of evidence is very inconvenient, but would be easier
to live with if it was more widely acknowledged in discussion of
implementation.
1. Freeman AC, Sweeney K. Why general practitioners do not implement
evidence: qualitative study. BMJ 2001; 323: 1100-1102.
2. Cleland et al. Long term anticoagulation or antiplatelet
treatment. BMJ 2001; 323: 233-236.
3. Clinical Evidence. Issue 5, BMJ Publishing Group, 2001.
Competing interests: No competing interests