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Information strategy

"That's the reason they're called lessons", the Gryphon remarked: "because they lessen from day to day."
Lewis Carroll, Alice in Wonderland

This issue of Bandolier focuses on lessons re-learned, and lessons, moreover, that do not lessen from day to day. We have learnt that studies that are not randomised over-estimate the effects of treatment, and those studies that are not double blind over estimate the effects of treatment ( Bandolier 17 ). Many times we find examples of this. This month we find two further pertinent examples.

One looked at interventions to reduce teenage pregnancies. It showed that observational studies found interventions to be successful. Randomised studies showed that they were not. The other looked at cisapride for non ulcer dyspepsia. A single large open study found fantastic efficacy with cisapride, though the placebo group was in line with that from double blind trials. The result of combining all studies was that the effect of cisapride was over-estimated by a substantial amount.

Information strategy

Another lesson is about the need for tools. "Give us the tools, and we will finish the job" said Winston Churchill. We need rapid access to knowledge. Yet a survey in primary care in the Northern & Yorkshire Region [1] showed only 22% of GPs had good access to electronic information in their practice. Other health professionals were way down the line.

Bandolier has its own solution. Buy an iMac for the practice. Buy Microsoft Office because it has Explorer. Buy the book reviewed in this issue with all the Internet sites you'd ever want. Take out a subscription to the Cochrane Library on-line, with about 800 reviews, 250,000 controlled trials, and much more. All this and still with change out of £1000 if you shop around. It's called an information strategy.

Professionals (and patients and the public for that matter), should be throwing tantrums: 'We want it now!'. That should apply to infotech, and to better knowledge about products. Try seeing all reps for one week, and saying that you will see them next when they have a systematic review of the product they are promoting. Quiet times ahead for you, headless chicken times at corporate HQ. But apply the tantrum information strategy to PCGs and Health Authorities as well.


  1. Access to the evidence base from general practice in Northern and Yorkshire region. NHS Centre for Reviews and Dissemination.

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