Sense about Science ? equipping people to make sense of science and evidence
Evidence based medicine matters
Medical Royal Colleges make commitment to evidence based medicine
On 25th April 2013, medical Royal Colleges told Parliamentarians that evidence based medicine is central to the success of modern healthcare and must be their aspiration. See comments about the Colleges' commitment.
Twenty medical Royal Colleges and the Royal Pharmaceutical Society made a commitment to evidence based medicine. They said they will continue to strive towards a solid evidence base for treatments because this gives doctors and patients the best foundation on which to base decisions. The colleges worked with Sense About Science and the Academy of Medical Royal Colleges to launch a booklet Evidence Based Medicine Matters of case studies of 15 of the game changers in evidence based medicine in their fields.
All agree that evidence based medicine must be at the core of medical Royal Colleges’ role in raising the standard of patient care. They also agree that there are frustrations and challenges to this aspiration. It will never be possible to investigate every intervention for every possible circumstance and some treatments escape rigorous scrutiny. Complicated discussions about whether funding, time and expertise should be focused on clinical research, basic research or training are going on. Grappling with these frustrations must continue. Medicine is driven by precisely this kind of critical approach. It is because medical professionals are willing to open things up for discussion again and again that we can move medicine forward.
Síle Lane, Sense About Science: “The Colleges have shown us that the caricature of modern medicine as immobile and blind to new ideas is wrong. The way doctors continually draw questions about treatments back into the frame stands in stark contrast to some traditional medical practitioners who champion long use of a treatment over anything else.”
Professor Terence Stephenson, Chairman, Academy of Medical Royal Colleges: “The 15 case studies illustrate the role evidence based medicine plays in shaping and influencing healthcare across the profession. The Academy and its members are committed to continually improve patient safety through the development and testing of treatments, tests and prevention strategies to take medicines and healthcare into the future. We are pleased that this booklet highlights that work and the dedication of the Colleges and Faculties to patient welfare through evidence based medicine.”
Martin Astbury, President of the Royal Pharmaceutical Society: “We believe evidence based medicine is the key to the success of modern healthcare. Modern medicine faces challenges every day from therapies that escape rigorous scrutiny: consider the scandal of £4M the NHS spends on homeopathy every year. By continually striving towards a solid evidence base for treatments we give doctors and patients the best foundation on which to base decisions. It is the ongoing process of testing treatments and collecting evidence that moves medicine forward. It is the basis for the extraordinary improvements in life expectancy and quality of life we have seen in the last century."
Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists: “Evidence-based medicine implies the integration of best research evidence with clinical expertise and patient values. It is the gold standard for clinical care and is vital towards continued best practice in women’s healthcare. Our clinical guidelines are updated when new evidence is produced and will continue to be reviewed to ensure the best treatments and procedures are available to women and their babies.”
Dr J-P van Besouw, President of the Royal College of Anaesthetists: “We believe exploration and research in medicine is essential for the development of improved treatments and enhanced patient care. This guide offers an excellent collection of case studies to inform and inspire doctors to continue the search for new evidence and improved practice. The Royal College of Anaesthetists was delighted to be involved with the publication – Evidence Based Medicine Matters.”
Dr Archie Prentice, President of the Royal College of Pathologists: “The accuracy and reliability of pathology tests continues to develop at a remarkable speed. The evidence these tests produce is essential for the precision, the clinical and cost-effectiveness and the safety of the practice of medicine across the board.”
Dr Cliff Mann, Registrar of the College of Emergency Medicine: "Evidence based medicine is key to delivering improved care and survival to emergency patients, recent studies have demonstrated how simple measures to treat serious bacterial infection are time critical; ongoing research in emergency departments will allow further refinements to current protocols. This will enable us to better target our interventions."
Professor Sue Bailey, President of the Royal College of Psychiatrists: “Much has been done to improve mental health in the last 10 years, including modern evidence-based treatments such as Cognitive Behavioural Therapy which is discussed in this exciting new publication. Mental health still does not receive the same attention as physical health. However, significant advances in treatment, diagnosis and research will help to address the disparity between physical and mental health, and will also improve the lives of our patients and their carers.”
Mr Ian Ritchie, President of the Royal College of Surgeons of Edinburgh: “The Royal College of Surgeons of Edinburgh is very supportive of the concept that medical professionals must consider the evidence that the interventions we use do work in fact and not just in our opinion. This applies not just to high tech procedures and equipment, but also to the way in which clinicians relate to all their patients.”
Professor James D Hutchison, Vice-president of the Royal College of Surgeons of Edinburgh: “As Sherlock Holmes author, Sir Arthur Conan Doyle (an Edinburgh doctor, trained by a President of the Royal College of Surgeons of Edinburgh) once said, ‘it is a capital mistake to theorise before one has data’. Evidence matters in medicine, and surgeons have a long history of recording their results. What has changed is that this is now embedded within routine practice, and the practice and development of surgery (techniques, individuals, implants) is subject to rigorous on-going assessment. That, surely, can only be to the benefit of their patients.”
Dr Diana Tait, Vice President (Clinical Oncology) of the Royal College of Radiologists: “Modern medicine is constantly developing and high quality evidence impacts the methods that we clinicians use to diagnose and treat diseases such as cancer. An evidence base allows us to be certain that we are offering the best treatment currently available and to quantify the benefits and risks of these treatments. By acquiring this kind of sequential evidence we can help to keep treatment and medical practice moving forward. At what is often a frightening and overwhelming time, we want our patients to have full confidence that the treatment they are receiving is based on solid knowledge and evidence.
“Evidence based medicine is at the heart of good medical practice and especially so in the work of clinical oncologists and clinical radiologists. As a wider profession the medical community must continue to invest in developing this base and strive to implement all of the developments that evidence suggests we need.”
Professor Neena Modi, Vice-President for Science and Research at the Royal College of Paediatrics and Child Health: “Whether it’s a new vaccination, a more effective form of treatment or a cure to a life-threatening disease – if we’re to meet the health challenges of the future, we have to be innovative. But our innovation must be based on evidence; testing and trialling treatments to ensure they are both safe and effective.
“In child health, over forty years ago, many children's diseases, such as leukaemia, cystic fibrosis, and newborn respiratory distress syndrome, were a death sentence. Treatment has improved because of evidence gained through the participation of children in clinical trials, and now the majority live long, healthy lives. We have to get the message across to parents, doctors and nurses, and NHS managers, that clinical research is very carefully reviewed and regulated, and that it is important to provide opportunity for children to be involved. This is vital to ensure that national clinical guidelines, policies and treatments are informed by research evidence so that the children ultimately benefit.”
Dr Keith Bragman, President, Faculty of Pharmaceutical Medicine: “The Faculty of Pharmaceutical Medicine fully endorses this important document, which outlines the significance of evidence-based medicine across the medical specialties. EBM is integral to pharmaceutical medicine and, as the section on HIV exemplifies, clinical trials performed on innovative medicines result in more effective and safer treatments, that save lives and can radically transform the quality of life of patients.”