Congratulations to Harriet Hunt

ESMIs very own Harriet Hunt was one of the winners of the recent Evidence Live 2015 competition which challenged aspiring PhD candidates and junior doctors to address the following questions in 300 words: “What is the most important intervention/change/idea required to ‘fix’ Evidence-Based Medicine over the next 10 years, and how should it be implemented?”. Harriet won substantially reduced rates to attend the Centre for Evidence-Based Medicine’s Evidence Live 2015, which is being hosted at the Oxford University Examination Schools on the 13th-14th April. Her entry is posted below:

Improving the evidence for Evidence-Based Medicine, by Harriet Hunt
How would you feel about a pharmaceutical manufacturer introducing a new drug without clear evaluation – no empirical evidence on benefits and costs to the target population, or implications if that drug is not used? They argue that comprehensive evaluation is too challenging – and besides, everyone knows it’s the right thing to use. It’s logical.

This is how Evidence-Based Medicine (EBM) could be viewed at present. After more than 20 years of teaching and refinement, EBM has its own acronym – yet still struggles to shift from totemic paradigm of medical education to practice standard1. Once trainees have fledged into clinical practice, the tenets of EBM may be a luxury rather than necessity for careworn clinicians.

Several barriers are attributed to this struggle2, yet a fundamental question is overlooked: does failure to consider the evidence always lead to poorer medical outcomes?

A 2011 Cochrane review by Tanya Horsley and colleagues3 offers an insight. The authors found that whilst teaching critical appraisal skills may improve the knowledge of healthcare professionals, there was a complete absence of evidence on whether teaching these skills led to changes in the process of care or changes in patient outcome.

More examples are needed of where failure to consider evidence would lead to poorer outcomes in real world scenarios. Without proof, it is difficult to persuade anyone, let alone sceptical, time-poor practitioners, that increased evidence really does make a difference.

1 Knottnerus, JA & Dinant, GJ (1997) Medicine based evidence, a prerequisite for evidence based medicine. BMJ 1997;315:1109
2 Greenhalgh, T, Howick, J, & Maskrey, N (2014) Evidence based medicine: a movement in crisis? BMJ 2014;348:g3725
3 Horsley T, Hyde C Santesso N, Parkes J, Milne R, Stewart R. Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD00127. DOI: 10.1002/14651858.CD001270.pub2