Documentos de Académico
Documentos de Profesional
Documentos de Cultura
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Analysis
ANALYSIS
ESSAY
Trisha Greenhalgh dean for research impact , Jeremy Howick senior research fellow , Neal Maskrey
3
professor of evidence informed decision making , for the Evidence Based Medicine Renaissance
Group
Barts and the London School of Medicine and Dentistry, London E1 2AB, UK; 2Centre for Evidence-Based Medicine, University of Oxford, Oxford
OX2 6NW, UK; 3Keele University, Staffs ST5 5BG, UK
1
The first problem is that the evidence based quality mark has
been misappropriated and distorted by vested interests. In
particular, the drug and medical devices industries increasingly
set the research agenda. They define what counts as disease (for
example, female sexual arousal disorder, treatable with
sildenafil16 and male baldness, treatable with finasteride17) and
predisease risk states (such as low bone density, treatable with
alendronate).18 They also decide which tests and treatments will
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ANALYSIS
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Box 2: What is real evidence based medicine and how do we achieve it?
Real evidence based medicine:
Makes the ethical care of the patient its top priority
Demands individualised evidence in a format that clinicians and patients can understand
Is characterised by expert judgment rather than mechanical rule following
Shares decisions with patients through meaningful conversations
Builds on a strong clinician-patient relationship and the human aspects of care
Applies these principles at community level for evidence based public health
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ANALYSIS
Conclusion
Much progress has been made and lives have been saved through
the systematic collation, synthesis, and application of high
quality empirical evidence. However, evidence based medicine
has not resolved the problems it set out to address (especially
evidence biases and the hidden hand of vested interests), which
have become subtler and harder to detect. Furthermore,
For personal use only: See rights and reprints http://www.bmj.com/permissions
Evidence Based Medicine Working Group. Evidence based medicine. A new approach
to teaching the practice of medicine. JAMA 1992;268:2420-5.
Pope C. Resisting evidence: the study of evidence-based medicine as a contemporary
social movement. Health 2003;7:267-82.
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ANALYSIS
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69
Cooke M, Irby DM, OBrien BC. Educating physicians: a call for reform of medical school
and residency. Wiley, 2010.
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