Evidence-Based Medicine Matters

Dr Irene Hames

Managing Editor, The Plant Journal

Patients place their trust in their doctors, and want to feel confident that they are receiving the best possible care and treatment. The practice of evidence-based medicine helps ensure this happens. It provides a framework whereby the best clinical and scientific evidence available is identified and appraised, and can then be translated into effective and safe everyday practice by doctors based on their own experience and, very importantly, knowledge of their individual patients. But just because research has been published this doesn’t necessarily mean it can be trusted, or that it represents a completely accurate picture. Studies may have been poorly designed or carried out. Some may subsequently be shown to be flawed, or even fraudulent. It is also widely recognised that there is bias in publication – for example, studies reporting positive results are more likely to be published than those with negative results, sponsors of work may be selective in what they put forward for publication, holding back unfavourable studies or misrepresenting findings by exaggerating the benefits and minimising the risks. The path from getting results to final publication and dissemination is a long and complex one. It is open to abuse and unethical practices, such as ‘ghost management’. Here people and companies not directly involved with the work manage its handling and publication, with the primary aim of achieving an outcome other than just the advancement of human knowledge, for example the promotion of a product for commercial gain. Sometimes, influential people who have contributed nothing to the work may even be added as authors to bestow authority and increase dissemination. How can healthcare professionals find their way through all this? Daily they face the challenge of keeping up with medical advances as well as providing care for their patients. For many it would be impossible to keep track of the rapidly expanding medical and scientific literature, let alone feel confident in its critical appraisal as part of their evidence-based treatment strategies. Luckily there are resources available – such as the Cochrane Library and the databases of the Centre for Reviews and Dissemination - that they can turn to and use to inform their decision making in the health care they give their patients. These identify the highest quality research evidence available on healthcare-related issues and clinical interventions and treatments, and provide systematic reviews of that evidence. In these days of ever-increasing availability of information where anyone can put anything up online, they provide a gold standard that can be trusted.