Saturday, March 19, 2005

Even the Masters of Evidence Based Medicine at McMasters Cannot keep up with the 55 new RCTS per day

An editorial in the March/April issue of the ACP journal Club(evidence-based medicine for better patient care) states that each year Medline indexes 560,000 new articles and Cochrane Central adds 20,000 new trials per year.(this is about 55 per day).The editorialists,Glaszious and Haynes, depress us further by revealing that the Cochrane group can only include less than 10% of the trials in their reviews and that a review of guidelines for treatment of atrial fibrillation showed that for twenty reviews "most" were not evidence based.They continue and quote a JAMA article that seems to show that guidelines don't follow guidelines.(JAMA 1999;281;1900-5,"Are guidelines following guidelines?" By Shaneyfelt TM et al)
And then the same issue of the journal itself-in a wierd self referential way- shows how impossible it is to keep up by publishing a review of a meta-analysis of estrogen use in urinary incontinence-claiming that estrogen helps-in their March/April issue even though JAMA in a Feb.issue published the WHI data (a RCT- which,of course, always trumps a meta-analysis)that showed estrogen makes incontinence worse.
Obviously,the issue went to press before the JAMA article was published but the whole thing struck me as ironic or illustrative of what general internists face with the imperative of trying to keep up in the face of too much to keep up with.The ACP Journal CLub publication does typically help in that effort, an occasional oversight notwithstanding.

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