Tag Archives: Clinical Research

Improving the Evidence

All good physicians want to do the right thing. They want to recommend effective therapies to their patients that will improve outcomes or alleviate symptoms. It is widely accepted that the best way to discover new effective therapies is through the use of clinical trials. Among clinical trials, the reference standard is the randomized, double-blinded, placebo-controlled trial, which is designed to minimize bias in the selection of therapies or the interpretation of results.

I have written before about the limitations of clinical research in advancing medical practice. As I have said, it is literally impossible to study every clinically relevant question, and it is also impossible even in theory to use randomized controlled trials as the methodology for many of the questions that can be studied.

A recent article in the New York Times highlighted another challenge to the paradigm of clinical trials as the engine for improving medical practice. The piece was about a change in policy at the National Institutes of Health, being implemented by Michael Lauer, the “newly appointed deputy director for extramural research.” In the interest of full disclosure, I have known Mike for many years (we were cardiology fellows in the same program at Boston’s Beth Israel Hospital in the late 1980’s) and you would be hard-pressed to find a nicer, smarter or more upstanding guy.
Continue reading Improving the Evidence

How Reliable is the “Evidence Base”?

Physicians are encouraged, in ways large and small, to practice “evidence-based” medicine, or EBM. The Centre for Evidence Based Medicine at the University of Oxford defines EBM as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

EBM is the basis for developing practice guidelines, and efforts to assess and improve the quality of care are now framed almost exclusively in terms of adherence to evidence-based practice. Continue reading How Reliable is the “Evidence Base”?