Guidance has high priority in interventional procedures
http://www.100md.com
《英国医生杂志》
EDITOR—I thank Anton Jacob for his comments on our editorial. The poor and scanty evidence on which many new interventions are based is self evident. We tried to explore some of the possible reasons. We made no claim that there were studies or "hard" evidence for the suggestion of "cultural and educational reasons"—this comment was simply proferred as one possible reason for the continually poor provision of evidence. Editorials are a vehicle for opinion and debate, not just facts.
The words were actually written by my coauthor, Tom Dent, who is a public health doctor and therefore in a position to comment on the behaviour of "interventionalists" from a good vantage point. Traditionally, surgeons (the largest group of interventionalists) have had a culture of developing new techniques with an eye to their early outcomes but generally without recourse to setting up good comparative studies. Of course they have received education in scientific methods and they value good evidence when it becomes available, but, by and large, most surgeons around the world do not participate regularly in good comparative trials when they adopt new techniques. I think that this is "cultural" and it is therefore inevitable that it should be "educational"—if only by a process of example.
Jacob's comment, that discretion has to be exercised for the greater good, hints at a culture that is outmoded and inappropriate. At NICE we involve patients, carers, and other lay people in the most wide ranging and unfettered discussions about all aspects of health care. Debate about the possible reasons for the imperfect practice of doctors in all kinds of areas can become much more challenging and uncomfortable than the suggestion we have made in our editorial. We welcome open debate like this, because it encourages critical examination of our practices and prejudices, which can do nothing but good in the longer term.
The words were actually written by my coauthor, Tom Dent, who is a public health doctor and therefore in a position to comment on the behaviour of "interventionalists" from a good vantage point. Traditionally, surgeons (the largest group of interventionalists) have had a culture of developing new techniques with an eye to their early outcomes but generally without recourse to setting up good comparative studies. Of course they have received education in scientific methods and they value good evidence when it becomes available, but, by and large, most surgeons around the world do not participate regularly in good comparative trials when they adopt new techniques. I think that this is "cultural" and it is therefore inevitable that it should be "educational"—if only by a process of example.
Jacob's comment, that discretion has to be exercised for the greater good, hints at a culture that is outmoded and inappropriate. At NICE we involve patients, carers, and other lay people in the most wide ranging and unfettered discussions about all aspects of health care. Debate about the possible reasons for the imperfect practice of doctors in all kinds of areas can become much more challenging and uncomfortable than the suggestion we have made in our editorial. We welcome open debate like this, because it encourages critical examination of our practices and prejudices, which can do nothing but good in the longer term.