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Reviving Cochrane's contribution to evidence‐based medicine: bridging the gap between evidence of efficacy and evidence of effectiveness and cost‐effectiveness
Author(s) -
James Jack E.
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12782
Subject(s) - internal validity , evidence based medicine , cost effectiveness , randomized controlled trial , misrepresentation , psychological intervention , scientific evidence , health care , medicine , alternative medicine , external validity , exaggeration , medline , psychology , nursing , risk analysis (engineering) , psychiatry , social psychology , political science , law , surgery , philosophy , epistemology , pathology
KeypointsThroughout the quarter century since the advent of evidence‐based medicine (EBM), medical research has prioritized ‘efficacy’ (i.e. internal validity) using randomized controlled trials. EBM has consistently neglected ‘effectiveness’ and ‘cost‐effectiveness’, identified in the pioneering work of Archie Cochrane as essential for establishing the external (i.e. clinical) validity of health care interventions. Neither Cochrane nor other early pioneers appear to have foreseen the extent to which EBM would be appropriated by the pharmaceutical and medical devices industries, which are responsible for extensive biases in clinical research due to selective reporting, exaggeration of benefits, minimization of risks, and misrepresentation of data. The promise of EBM to effect transformational change in health care will remain unfulfilled until (i) studies of effectiveness and cost‐effectiveness are pursued with some of the same fervour that previously succeeded in elevating the status of the randomized controlled trial, and (ii) ways are found to defeat threats to scientific integrity posed by commercial conflicts of interest.