While evidence-based medicine (EBM) developed over 20 years ago to meet the needs of healthcare systems at that time, there is continuing debate about its current relevance. As with any innovation, there is a need for the paradigm to adapt to the changing circumstances of international health systems. Part of this process of sustaining innovations requires monitoring of problems along the way, which in turn, sets the scene for identifying and prioritizing new activities.
A small group of committed experts and postgraduate students met at Kellogg College during the University of Oxford’ s Alumni weekend to review the problems and progress of evidence-based health care. Professor Paul Glasziou set the focus in investigating waste in research, as an important step towards understanding how we ensure research makes a positive difference for patients, in their health care. Over the last 8 years, he has led the way in defining and describing 5 key stages in research where waste is a big problem;
- Are research questions relevant for clinicians and patients?
- Is research designed using the most appropriate study design and research methods?
- Is research conducted efficiently?
- Are full research reports published and accessible?
- Are research reports unbiased and usable?
A recent series of articles which were published in the Lancet, have been made public, and with other resources, they provide an important basis for understanding this complex problem. It is difficult to determine where to start to improve the widespread understanding of research. Three other speakers shared some examples from different perspectives of understanding and using research to improve healthcare.
Following on, Sir Iain Chalmers shared the work he and others are doing to help the public understand and engage in better research for better healthcare. The Testing Treatments interactive website now exists in ten languages. He described his work with GenerationR – the children and young people who are members of NIHR’s advisory groups for its Clinical Trials Networks, and the CEBM’s recently launched schools initiative. These developments reflect recognition of the importance of collaboration to improve general knowledge among young people about evidence-based medicine.
Amy Price has clearly been influenced by the work through the work of INVOLVE and by the James Lind Alliance (also developed by Iain Chalmers) in bringing together patients, their carers and clinicians to identify and prioritise ‘unanswered questions’, about the effects of treatments that they agree are most important. As a DPhil student, she is keen to promote public participation in research, through designing and participating in online clinical trials, to answer important questions. In this way, interested people can participate in research that will ultimately improve healthcare practice. Through involvement, she anticipates that people will learn about and remember the benefits of medical research. Opportunities for research involvement and collaboration are shared on the ThinkWell website.
Professor Carl Heneghan shared stories from his extensive research career and called for better prevention, clinical care and improved business processes in healthcare. On the one hand, he suggested that only 10 from every 1000 people actually benefit from weight reduction programmes. Yet on the other side, he pointed to the success that patients with insulin dependent diabetes have from managing their own insulin, which is a drug that can cause death within minutes if it is improperly used. He called for health leaders to challenge poor decisions and decisions not based on evidence. He also urged us to think differently about patients managing their own self-care, by ensuring that people are in the right position to make the right decisions. We need to engage the smart people around the world, and teach people critical thinking skills for understanding and using the research evidence.