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Evidence-based medicine in Iberoamerica, problems and possible solutions

Posted by plosmedicine on 30 Mar 2009 at 23:43 GMT

Author: Zulma Ortiz
Position: Coordinator
Institution: The Argentine Collaborating Center of the Iberoamerican Cochrane Network
Additional Authors: Pablo Perel and Jordi Pardo
Submitted Date: June 23, 2005
Published Date: June 24, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We want to congratulate the authors, who summarize very well the main problems that evidence-based medicine faces in developing countries. As members of the Iberoamerican Cochrane Network we would like to share some lessons learned and highlight possible solutions to the problems identified by Chinnock et al.

We have learned from the experience of working in and with Latin American countries that one of the first barriers to overcome is inequities in accessing evidence. The second barrier for such countries is the English language. Efforts have been made by our Network to overcome both barriers by providing free access to the Biblioteca Cochrane Plus (BCP). As well as systematic reviews and protocols, this database contains evidence-based information not indexed in other sources.

However, ensuring access does not necessarily mean that reviews will be used in decision-making. Many local problems do not appear in the BCP material but those which are most prevalent and those with high-impact on public health and clinical practice of these countries have been reviewed. Nevertheless, few health professionals apply the results of such reviews. One possible solution is that Cochrane centers, groups or fields, most of which are based in developed countries, could invest resources in mass dissemination and promote their activities through organizations such as the Pan American Health Organization. This would encourage not only the use of systematic reviews, but also promote an interest in the Cochrane Collaboration from health authorities in the Americas.

Another aspect revealed in Chinnock's article is the need to get more people from developing countries involved in writing and peer-reviewing systematic reviews. The nature of the Cochrane Collaboration facilitates this and we have had excellent results when working with several of its groups and fields. However, developing countries have a limited number of people qualified to participate in the writing and peer-reviewing of systematic reviews. Most of those who have the necessary skills have to contend with an enormous load of teaching and clinical care, their salaries are insufficient to support a white-collar lifestyle, and thus private practice is the most common means of augmenting earnings. These economic issues are by far the major factor underlying the relative lack of research in developing countries. Cochrane groups and centers based in developed countries should identify potential reviewers and invest resources that provide them with spare time to devote to the promotion, production and evaluation of systematic reviews. This idea is in line with the millennium goals; specifically number eight, which address the need to develop a global partnership for development. Nevertheless, the concerns exposed in connection with the search for reviews performed in developing countries would lessen if the use of databases specific for these regions, such as LILACS in the Latin American area, was encouraged, and if their use and development were supported.

Finally, we consider that advocacy on the importance of research and evidence-based public health should be strengthened in developing countries. This has been highlighted by Bernardo Houssay, the first Latin American honored with the Nobel Prize, who said, 'Science is only science when it involves constant progress and improvement arising from research. Thus, there are only two possible standpoints: that of tuggers and that of others being tugged. In other words, you may either create knowledge at the same time others do, or accept a subordinate position and depend on what others produce'. When the response to his views was different from what he expected, he added, 'It would not be ethical to base a research strategy on the unfair exploitation of sacrifices made by those with exceptional and determined minds. Wise countries do not live waiting for saints or miracles to occur.

1) Chinnock P, Siegfried N, Clarke M (2005) Is evidence-based medicine relevant to the developing world? PLoS Med 2(5): e107.
2) Biblioteca Cochrane Plus available in http://
) Bhutta Z. Practising Just Medicine in an Unjust World. BMJ 2003;327;1000-1001
) United Nations. Millennium Development Goals. Available Accessed June 11 2005.
) Charreau E. Discurso por incorporacin a la Academia Nacional de Medicina. Available Accessed June 11 2005.

No competing interests declared.