Thursday, December 30, 2004

McMaster Clinical epidemiology Group: Evidence based medicine is best spoon fed

In an April 2000 BMJ editorial(BMJ 2000:320. 954-955 (8 April)) Jaeschke,Cook and Haynes-from the McMaster Clinical epidemiology Group- state that their residents as well as British GPs prefer "preappraised " evidence, rather than doing the analysis themselves. They have concluded that not all trainees are interested in attaining advance EBM analytic skills. The interesting thing here is how the authors reached that conclusion. It was not through a randomized controlled trial, nor was it through a systematic observational study but as they admit "after a decade of unsystematic observation".This is the type of clinical evidence that they -rightly enough-have placed on the bottom tier of the clinical evidence hierarchy. Is this not the same type of evidence that they denigrate in their advocacy of the RCTs. How does their pronoucement differ from the dogma that old clinical profs passed down to their proteges? And yet it is on that basis that they make their recommendation of best ensuring evidence based care by supplying preappraised evidence based summaries. Does this sound like "Don't worry we will analyze the data and tell you what to do"? Is there a difference between the dogma we learned from old clinicians based on their experience and the dogma from the EBM analytic experts? In either case it seems the trainees of days gone by and the trainees of today want to be told what to do. What do the trainees do when two meta analyses on the same issue differ?

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