What is Right and What is Wrong About Evidence‐Based Medicine?

Julian, Desmond G.

doi:10.1046/j.1540-8167.14.s9.18.x

Cited by 20 publications

(14 citation statements)

References 16 publications

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“…45,46 Conflicts of interest can arise from when investigators or funders of studies deploy strategies that influence the results such as (1) selecting specific designs and hypotheses-for example, choosing noninferiority rather than superiority approaches, 47 picking comparison drugs and doses, 47 choosing outcomes, 46 or using composite endpoints (e.g., mortality and quality of life) without presenting data on individual endpoints; 48 (2) selectively reporting outcomes -for example, reporting relative risk reduction rather than absolute risk reduction; selecting from multiple endpoints 47 or reporting on subscales of larger scales; reporting inappropriately developed categorical variables, based on selected cut-points in continuous measures; 49 (3) presenting results in a biased 48 or inadequate manner 49 and (4) failing to publish results, thereby contributing to publication bias. 50 EPCs can evaluate these pathways if and only if the relationship between the sponsor(s) and the author(s) is clearly documented; in some instances, such documentation may not be sufficient to judge the likelihood of conflict of interest (for example, authors may receive speaking fees from a third party that did not support the study in question).…”

Section: Conflict Of Interestmentioning

confidence: 99%

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

et al. 2017

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The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policy makers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied. Persons using assistive technology may not be able to fully access information in this report. For assistance, contact epc@ahrq.hhs.gov. PrefaceThe Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public-and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.Strong methodological approaches to systematic review improve the transparency, consistency, and scientific rigor of these reports. Through a collaborative effort of the Effective Health Care (EHC) Program, the Agency for Healthcare Research and Quality (AHRQ), the EHC Program Scientific Resource Center, and the AHRQ Evidence-based Practice Centers have developed a Methods Guide for Comparative Effectiveness Reviews. This Guide presents issues key to the development of Systematic Reviews and describes recommended approaches for addressing difficult, frequently encountered methodological issues.The Methods Guide for Comparative Effectiveness Reviews is a living document, and will be updated as further empiric evidence develops and our understanding of better methods improves.If you have comments on this Methods Guide paper, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research a...

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Section: Conflict Of Interestmentioning

confidence: 99%

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

et al. 2017

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“…Many practitioners dealing with individual patients have not fully appreciated, for example, that although CPGs often use broad-based topical headlines such as osteoporosis or asthma, individual patients frequently fall outside the demographics of the specific groups studied to prepare the CPGs. 29 Frequent examples of this include patients whose specific age group was not researched, patients receiving concomitant therapies, and patients with coexisting medical problems, all groups for whom data may simply not be available. It has also become evident that most CPGs focus heavily on clinical trials and therapeutic interventions, often neglecting etiology, prevention, health promotion, and long-term risks.…”

Section: Clinical Practice Guidelines and The Standard-of-carementioning

confidence: 99%

The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers?

Genuis¹

2005

The Journal of the American Board of Family Medicine

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In a medical milieu of extensive research, rapidly proliferating information, and a multitude of potential therapies, there has been an escalating trend toward the development and dissemination of clinical practice guidelines outlining investigative and management protocols for clinical problems. There are substantial benefits to providing educational directives and securing widespread adherence to specific clinical practice standards as a means to ensure a consistent acceptable standard-of-care. On the other hand, the increasing tendency to regard authoritative documents as dogma may hinder ongoing medical progress and facilitate the adoption of a "follow-the-recipe" approach to medical practice. A healthy tension between physician autonomy and recommended practice guidelines needs to be cultivated in primary care as well as in specialty clinical practice. In response to increasing concern surrounding issues of impartiality and commercial influence on the development of practice directives, a mechanism designed to assure integrity and credibility of guidelines is required. The important thing is never to stop questioning.-Albert EinsteinWith ever increasing attention given to evidencebased medicine, the proliferation of practice directives in the form of clinical practice guidelines (CPGs) has become a primary mechanism for communicating clinical aspects of emerging therapies and "standard-of-care" expectations to practicing physicians. Recent discussion in the medical literature, however, suggests a need for caution when implementing recommendations contained within CPGs. The initial spark that ignited my apprehension about practice directives and standard-of-care pronouncements involved the issue of hormone replacement therapy (HRT). When it became fashionable to use HRT containing estrogen and progesterone to prevent osteoporosis, heart disease, and cognitive decline in women, I considered the putative benefits with a somewhat jaundiced eye. During my residency training I had read extensively on the relatively recent diethylstilbestrol (DES) estrogen therapy fiasco, the resultant birth abnormalities, the reproductive dysfunction, and the cancerous sequelae. In an environment of mounting pressure to recommend widespread use of long-term HRT as preventive therapy for healthy women, I reviewed the available information and research. I was astonished to find that within a medical paradigm that emphasizes evidence-based medicine, there was a remarkable paucity of scientific evidence for long-term preventive HRT as the standard-of-care for postmenopausal women. Moreover, I did not understand how HRT had catapulted to become the leading drug sold in America.

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“…Another important point is the difficulty to publish studies with negative results. Although the papers regarding an effective treatment method are accepted more easily, those indicating ineffective treatment methods are somehow considered invaluable (4).…”

Section: Introductionmentioning

confidence: 99%

Recent Landmark Studies on Head and Neck Cancers: Evidence-Based Fundamentals of Modern Therapeutic Approaches

Aydíl

2015

Turk Arch Otolaryngol

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ReviewEvidence-based medicine, established on prospective studies and related algorithms is living its golden age in recent years. Within the last few decades, medical knowledge has been systematically produced, categorized, and spread in a way never seen before. One of the most important factors in realizing this situation is the expansion of the communication facilities. The area of the management of head and neck cancers was also affected by these advances, and studies with high-level evidence became the mainstay in the determination of the management strategies. However, probably almost all of these studies are about non-surgical modalities, and studies with high-level evidence regarding the surgical treatment of head and neck cancers are scarce. In this paper, important studies on head and neck cancers and their results will be reviewed. Keywords: Head and neck cancers, prospective studies, evidence-based medicine

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What is Right and What is Wrong About Evidence‐Based Medicine?

Cited by 20 publications

References 16 publications

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions

The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers?

Recent Landmark Studies on Head and Neck Cancers: Evidence-Based Fundamentals of Modern Therapeutic Approaches

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