Not only does it provide some excellent examples to help explain why EBM matters, but also it shows the unanimity across the health professions about the benefits of integrating evidence from systematic research into practice.

Download the booklet as a PDF

The following Colleges took part:

• Royal College of General Practitioners:  a 2004 randomized trial showed that steroid treatment works for Bell’s Palsy.
• Royal College of Pathologists:  a 2010 trial showed that a simple, non-invasive test reduced the need for invasive colonoscopies for suspected bowel cancer.
• Royal College of Anaesthetists: 2007 review found that a Doppler probe reduced complications amongst patients undergoing surgery.
• Royal College of Paediatrics and Child Health: Although a 1972 controlled trial had shown steroids improve survival for pre-term infants, it took a 1992 systematic review and guideline to change practice.
• College of Emergency Medicine:  The College systematically identified important uncertainties in practice concerning the care of people having severe allergic reactions.  They reviewed the evidence and produced clinical practice guidelines in 2009.
• Royal College of Radiologists:  A clinical trial enabled researchers to optimise (and shorten) the dosage regimen for breast cancer patients.
• Royal College of Obstetricians and Gynaecologists: retrospective research helped to resolve uncertainty about the best delivery options for breech birth babies.
• Faculty of Public Health:  Public health policy on smoking saves lives
• Faculty of Pharmaceutical Medicine:  Evidence from practice and from clinical trials transformed HIV from a deadly infection into a chronic, manageable condition.
• Royal College of Opthalmologists:  Genetic testing prevented unnecessary treatment and identifies patients who can benefit from screening for intraocular melanoma.
• Royal College of Psychiatrists:  Evidence shows that cognitive behavioural therapy can be effective for anxiety, depression, obsessive-compulsive disorder and post-traumatic stress disorder.  It can be effective in combination with pharmacological treatments.
• Faculty of Occupational Medicine: Acting on audit data improved working conditions for health professionals.
• Royal College of Surgeons of Edinburgh:  Surgeon’s performance was improved by training in non-technical skills such as communication and listening.
• Royal College of Surgeons of England:  Reducing deaths from bowel cancer by training surgeons in how to perform kehole surgery.
• Royal Pharmaceutical Society: Helping patients to remember to take their medicines.

The document also contains a short background to clinical research and suggestions for further reading.

About the Authors

Sense About Science is a charity that aims to help people to make sense of scientific and medical claims in public discussion.  They work in partnership with scientific bodies, research publishers, policy makers, the public and the media, to change public discussions about science and evidence.

Academy of Medical Royal Colleges exists to promote, facilitate and where appropriate co-ordinate the work of the Medical Royal Colleges and their Faculties for the benefit of patients and healthcare.

Please be advised that this list is indicative, not comprehensive!  We want to hear your examples;  tell us about them below.

Both patients and professionals will benefit from taking five minutes to watch this video.  It is also supplemented by a collection of resources that provide more detail on the implementation and evaluation of programmes in shared decision-making.

Click the image to view the video

The video, which can’t be embedded on other sites, deals with MAGIC, or ‘making good decisions in collaboration’, the Health Foundation‘s training and development programme to implement and evaluate shared decision-making in clinical practice.

According to the website, MAGIC is about coming up with practical solutions that can be applied across different areas of practice and creating a culture where shared decision-making can thrive.

As well as the five-minute video, the website includes details of the programme rationale, how and where it has been implemented, information about evaluation, case studies and a library of background reading.

The case studies include real-life examples in:

• general practice
• breast cancer care
• urology
• head and neck cancer
• quality improvement
• obstetrics

About the Health Foundation

The Health Foundation is “an independent charity working to improve the quality of healthcare in the UK”.  Much of their work focuses on patient safety and patient-centred care.

The Foundation is funded from an endowment received in 1998 from the sale of the PPP Healthcare Medical Trust.

This practice, sometimes driven by over-protective regulators, can be harmful because it stops us from finding out how well these treatments work for these patients.

The entire blog post is reproduced here by kind permission.  You can visit Statistically Funny to sign up for updates and view the archive.

It’s the Catch-22 of clinical trials: to protect pregnant women and children from the risks of untested drugs….we don’t test drugs adequately for them.

In the last few decades, we’ve been more concerned about the harms of research than of inadequately tested treatments for everyone, in fact. But for “vulnerable populations,” like pregnant women and children, the default was to exclude them.

And just in case any women might be, or might become, pregnant, it was often easier just to exclude us all from trials.

It got so bad, that by the late 1990s, the FDA realized regulations and more for pregnant women – and women generally – had to change. The NIH (National Institutes of Health) took action too. And so few drugs had enough safety and efficacy information for children that, even in official circles, children were being called “therapeutic orphans.” Action began on that, too.

There is still a long way to go. But this month there was a sign that maybe times really are changing. The FDA approved Diclegis for nausea and vomiting in pregnancy. It’s a new formulation of the key ingredients of Bendectin, the only other drug ever approved for that purpose in the USA. Nothing else has been shown to work.

Thirty years ago, the manufacturer withdrew Bendectin from the market because it was too expensive to keep defending it in the courts. It’s a gripping story, involving the media, activists, junk science and some fraud. It had a major influence on clinical research, public opinion and more. You can read more about it in my guest blog at Scientific American, Catch-22, clinical trial edition: the double bind for women and children.

In dozens of court cases over Bendectin, judges and juries struggled with competing testimony about scientific evidence. In one hearing, a judge offered the unusual option of a “blue ribbon jury” or a “blue, blue ribbon jury”: selecting only people who would be qualified to understand the complex testimony and issues of causation. The plaintiffs refused.

Ultimately, in one of the Bendectin cases, Daubert versus Merrell Dow Pharmaceuticals, the Supreme Court re-defined the rules around scientific evidence for US courts. The previous Frye Rule called for consensus. The 1972 Federal Rules of Evidence said “all relevant evidence is admissible.”

The new Daubert standard determined that evidence must be “reliable” – grounded in “the methods and procedures of science” – not just relevant.

We still need everyone involved to better understand what reliable scientific evidence on clinical effects really means, though. You can read more about that here at Statistically Funny.

The talk was recorded at Seattle Town Hall, USA on 18th Feburary 2013. The video is hosted on the C-SPAN website and includes a partial transcript.

His topics include:

1. missing trial data:  it is estimated that about half of the trials that have been completed have not been published, and that trials with a positive result in favour of a new treatment are about twice as likely to be published as trials that do not have a positive result.
2. structural problems with randomized trials that might prevent them from being fair tests of treatments.
3. marketing of drugs to doctors.

View the full video.

In this cartoon, entitled “Nervously approaching significance“, Hilda addresses one of the key problems in making sense of research reports.  Statistical significance is important to rule out the play of chance in the results of research, but it’s not the whole story.

Use the link to see the full cartoon on Hilda’s blog.

We’re deluged with claims that we should do this, that or the other thing because some study has a “statistically significant” result. But don’t let this particular use of the word “significant” trip you up: when it’s paired with “statistically”, it doesn’t mean it’s necessarily important.

In this cartoon, Hilda reminds us that we can sometimes be blinded by statistics.  It’s important to remember that, in looking at the benefits of a treatment, not only do the results have to be statistically significant (i.e. unlikely to have happened if there were no benefit from the treatment), but they must also be important to the patient.

This “clinical significance” is a value judgment, based on a shared understanding between the patient and the carer.

Read more.

Many people think that Big Data offers tremendous potential in health care in analysing health outcomes of large populations.  However, as this cartoon illustrates, these new technologies could still be stymied by old problems, such as failure to disclose the data in the first place.

The cartoon first appeared on the Spanish language website Sin estetoscopio

• View the original in Spanish
• View Testing Treatments in Spanish
• Find out more about the background to Big Data on Wikipedia

The main messages of the video are:

• Know the evidence
• Don’t just blindly follow guidelines
• Involve patients in decision-making

The video is hosted on YouTube and was produced by James McCormack.

A lyric sheet is provided and there is also a Spanish translation.

The presentation explains relative risks, confidence intervals, forest plots, and standard and cumulative meta-analyses.

Read on to watch the video or download the slides.

Click Lisa & Steve’s picture to watch the video

Watch the video

Systematic reviews are the best way to understand the effects of treatments because they consider all the relevant, reliable evidence.

This resource will be useful for teachers, lecturers or others who want to explain systematic reviews using clear and informative visuals.

You can watch the video (8 minutes 23 seconds) by clicking Lisa and Steve’s picture on the right. The video is in M4V format.

You can also download the slides (926 KB, PPT format).

This simple animation by the ALOIS Community provides a lay-friendly introduction to the importance of having enough participants in fair tests of treatments and the need to be wary of statistics such as p values being used to distort our perception of research findings.

• View the animation

The animation requires Flash in order to run.

The ALOIS Community project is run by a small friendly team based at the John Radcliffe Hospital in Oxford, UK. In addition to the Princess animation, ALOIS has created an interactive online course Making Sense of Research and Evidence in Dementia. 

Their materials are designed to encourage involvement and participation in research by health care consumers, and offer an innovative way of contributing to the work of The Cochrane Collaboration.

Background to ALOIS

The original ALOIS Community volunteer project tested the feasibility of recruiting carers and former carers of people with dementia to an online information gathering task, vital to the production of high-quality, up-to-date systematic reviews.

The theory behind the project was that having interested and motivated lay people actively involved in real Cochrane work could be a more powerful engagement tool than disseminating reviews or teaching critical appraisal skills.

The ALOIS Community has now developed into a citizen science and crowd-sourcing project, investigating whether this people-power principle can be used to engage and involve other important interest groups, such as schoolchildren.

The ALOIS team are working hard to develop a larger portfolio of online information gathering tasks related to the production of systematic reviews across all healthcare areas. They believe that there is huge potential in facilitating the contribution of much larger numbers of people in the important work of the Cochrane Collaboration in producing up-to-date and patient relevant systematic reviews.

This sort of “learning through doing” is an extremely powerful way of engaging people, and building up their knowledge of and enthusiasm for fair tests of treatments.

• Find out more about ALOIS

Specifically, these are: failing to address issues that are of interest to patients and clinicians, failing to contextualize new findings, failing to communicate clearly what their results are, and failing to publish negative or disappointing results.

This video was originally posted in the Faculty of 1000 blog.