TechArchive

Original article date: November 1997

There’s a buzzword in medicine at the moment which is ‘clinical effectiveness’. It is accompanied by the phrase ‘evidence based medicine’. What it means is “treating patients in a way which has been shown to work”.

Now you may be horrified to learn that this hasn’t always been the way things are done, but it’s all a bit more complicated than that. You see, true “evidence-based-medicine” means:

– There has been a study with statistically significant results which points towards using a particular treatment

– A guideline has been produced which shows how and when to use the treatment

– All doctors must have read it and must put it into practice.

Now consider the following situation. There’s a drug which, if administered immediately after a heart attack, in the right circumstances can limit the damage or even reverse the effects. There’s a very small risk that a patient will suffer a stroke as a result of receiving this drug. And usually, the doctor can figure out which patients might be more susceptible to that risk than others, in which case the drug isn’t used. In a small (and it should be stressed, very small) proportion of cases, it can happen unexpectedly.

Consider Dr.A, who has used this drug five times, and in every case the patient made a 100% recovery from the heart attack with absolutely no permanent damage. Meanwhile, Dr.B has used the drug once, and the patient expired there and then -while being treated for a non-fatal heart attack! Dr.B might never use it again. Would you?

It should be clear then that in this case we do not have two doctors whose decision to use this drug will be based on exactly the same criteria. And you might say that until doctors were absolved from blame for things that happened when they followed official guidelines, against their personal judgement, they never will.

Anyway, why am I talking about this? Well, did you read the definition of ‘evidence based medicine’ above and think “That’s just common sense. How else would you work?”. And did you smugly think “In engineering we’re far more logical”? Because if you did, I beg to differ. OK, so faced with a machine which has stopped, we’d probably all diagnose the same blown fuse; we’d maybe even use a similar troubleshooting approach. But answer me this: Whose pneumatics last longest? Which company produces the best electric motors? Are all extruded aluminium frame building systems equally rigid, or strong?

Have you ever actually seen any of these things honestly compared side by side?

Or are your purchasing decisions influenced by who has a good rep, a well targeted advert, or whose product once let you down about ten years ago (and you’ll never forgive them for it). We don’t have a Which? magazine in our industry. And if we did, the suppliers would not all volunteer to take part in straight side by side tests. (Remember the Which? study that showed Metros were iffy in 40mph crashes? Did Rover say “it’s a fair cop guv”? Did they hell!).

So what I think we really need are a few more independent comparisons. Magazines run a few (bearings, servos, frame building systems) but what they really end up comparing is the quality of response, not the technical data. Real technical comparisons are expensive. And the only way they’ll happen is if every time a rep comes round we say “Is there any independent test data?” until they all get the message that their “We’re the best but we won’t prove it” stance is just unacceptable.

What do you think?

November 1997