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Déjà vu all over again

Déjà vu all over again
Toss of a coin
Watered wine

Déjà vu all over again

Bandolier seems to have spent much of the last decade or so urging caution on people who want to rush through major changes on the basis of some new "evidence". One points out that "new" and "evidence" in the same sentence is an unlikely and sometimes unfortunate pairing, but one is told off as being an old fool.

While that might be an excellent and accurate description for many reasons, this isn't necessarily one of them. We have learned, often painfully, that the requirements of evidence are not easily come by, and that it is all too easy to be misled. It is therefore comforting, at least to Bandolier, to see a brace of fine papers from Greece, extolling the philosophy of caution in the face of the popular. Just because wisdom is received, often just through repetition, that doesn't make it right. If we want to be right we need good evidence, and we need to look at the totality of evidence.

Toss of a coin

Bandolier well remembers speaking with a Medical Director of an organisation who espoused the opinion that evidence from a trial of 20 patients with statistical significance at the 5% level was sufficient evidence to make a change in policy. The chances of any such evidence being right, or at least strong, is about 10 to 1 against or worse.

Watered wine

These papers underscore our need to reduce the amount of dross in the medical literature, and, rather, concentrate on doing fewer but better studies on what is important. That is easier said than done, given the vagaries of finding cash or other resources to support research. We need stronger stuff than the watered wine so often put before us. Yes, there is some good stuff in the literature, but one might argue that good evidence in the medical literature is as rare as having an active ingredient in a homeopathic medicine.

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