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Problems and solutions (Editorial)

This month Bandolier does something different from the usual trawl of the literature to find high-quality evidence. At the behest of readers, we have chosen to try to make sense of the evidence around the new Cox-2 inhibitors, or coxibs as they are being called.

Problem


This is fundamentally different from finding a systematic review, meta-analysis, or other report that contains golden nuggets of information or mining those nuggets and shaping them into a valuable piece of knowledge. The problem with new interventions is that the amount of information available to the professions or public at large is initially very limited.

Reasons


The reasons for this are obvious. The basic research has to be done, early clinical trials undertaken to demonstrate that the intervention works, larger studies to define doses or routes of administration, and finally large randomised trials to demonstrate efficacy unequivocally, and, to a limited extent, safety. This will be available to registration authorities, but it takes time for papers to be written, peer-reviewed, and published. So new interventions come along without a systematic review of all studies, the type of evidence we increasingly depend upon to make sensible decisions.

Future


It is possible that all the new health technology assessment organisations around the world will provide what we want. But the NICE report will not be available for some months, about a year after Cox-2s first became available in the UK. The Bandolier approach is to review what is published now, with an updated Internet site as more information becomes available. We'd love to hear from companies when new papers are published, and from readers who see substantive evidence that can help.


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