Healthy Skepticism Library item: 20297

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Lilford RJ, Pauker SG, Braunholtz DA, Chard J.
Decision analysis and the implementation of research findings.
BMJ 1998 8; 317:(7155):405-9
http://www.bmj.com/content/317/7155/405?view=long&pmid=9694762

Abstract:

Evidence based medicine is more than just reading the results of research and applying those results to patients because patients have particular features that may make them different from the “average” patient studied in a clinical trial.1There are two types of differences. The first type of differences comprise those that affect probability (for example, the probability that treatments will have the same absolute or relative effects as those measured in the trial). The second type of differences comprise those values (or utilities) that affect how much of a side effect a person is prepared to trade off against the positive advantages of treatment.

Thus it is necessary for doctors to relate the results from a trial to their particular patient. Health professionals usually do this intuitively, but formal decision analysis provides an intellectual framework for developing an explicit decision making algorithm which can be criticised and improved. Although, currently, time constraints make it unrealistic to conduct a separate decision analysis for each patient, computer programs may soon help overcome this problem. It is, however, feasible for decision analyses to be done for categories of patients with similar clinical features and personal utilities. The results of such generic decision analyses provide a sound basis for developing clinical guidelines. Decision analysis thus provides a rational means of allowing health professionals to move from finding evidence to implementing it.

Keywords:
Decision Support Techniques* Probability Professional Practice* Research* Sensitivity and Specificity

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909