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Too Canute like?

Posted by Richard1 on 28 Sep 2010 at 10:07 GMT

The article by Hilda Bastian and others is rightly attracting a lot of attention, and I wanted to add a few thoughts.

1. Many people reading their article might reach the conclusion that Archie Cochrane's dream is unachievable and ought perhaps be replaced by something less Utopian.

2. Have the authors noticed something of a swing away from evidence based practice? I have--despite being an enthusiast since the very beginning. Many people, including many doctors, most policy makers, and even some statisticians, have come to see it as too reductionist, unhelpful in answering the complex questions of a world dominated by people with polypathology.

3. Their tendency to be sceptical about the inclusion of non-randomised trials and other evidence in systematic reviews puts them at risk of becoming pure but irrelevant.

4. They need a more sophisticated prescription for achieving their goal. In their next article they should analyse the incentives, many of them perverse, that leads to our present circumstances and propose ways of changing the incentives.

Competing interests declared: 1. I regard all three authors as friends, even though Iain disapproves of my career path.

2. I am the chair of the Cochrane Library Oversight Committee.

3. I am on the board of the Public Library of Science.