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Growing confidence in evidence-based medicine

CHENNAI: If you are a doctor, does it sometimes bother you that you have to recommend a particular drug or procedure without being entirely convinced of its effects and/or side effects? If you are a patient, are you constantly asking questions about the treatment you have been advised?

If you belong to either category, it might interest you to know that there is a growing confidence in evidence-based medicine. The Cochrane Collaboration’s reviews might ease the decision-making process. An international, not-for-profit organisation, the Cochrane Collaboration aims at improving healthcare decision-making through systematic reviews of the effects of healthcare interventions.

Since 2004, the South Asian Cochrane Network (SACN) has promoted Cochrane activities in India through a co-ordinating centre at the Christian Medical College, Vellore, with funding from the Indian Council for Medical Research. Six SACN sites are located in India and in a few months an independent Cochrane Centre will be established. The 2nd South Asian regional symposium on Evidence Informed Health Care will be held at the CMC on April 9.

Prathap Tharyan, co-ordinator, SACN CMC Vellore, explains in a paper he co-authored with Claire Allen and Mike Clarke that a systematic review helps identify which forms of healthcare work, which do not, and which are harmful.

In effect, the Collaboration, through its reviews, tries to identify treatments that are effective, inexpensive and with the least side effects. Each review takes into consideration all relevant published studies from prominent journals, non-indexed journals and non-published studies as well, meta-analyses all data systematically to arrive at a statistically reliable result.

“No physician wants to hand out ineffective treatments. But finding evidence that is up-to-date is a daunting task,” says R. Sridharan, one of the co-ordinators of the Chennai site of SACN. Medical literature is unwieldy, disorganised and biased, he adds, and finding one’s way through the jungle of evidence takes time, skill and perseverance.

The decision to use a particular intervention, such as a drug, requires balancing several crucial pieces of information. The likely benefits need to be evaluated against the likely harms for each option considered, Dr. Sridharan explains. In addition, it is necessary to factor in patient preferences, he adds.

SACN has several review groups in India that periodically update information on the Cochrane Library, even as evidence from the rest of the world pours in. Currently, Dr. Sridharan says, efforts are on to encourage practitioners of Indian Systems of Medicine to validate their formulations through SACN. Thanks to the ICMR, Indians can access all content on the website ( www.thecochranelibrary.com) free of charge.

Additionally, each Cochrane review has a “lay language” option — for patients. “We are trying to get the consumer to understand treatment. In India, only doctors call the shots. With knowledge, people can change the existing profit-based system of medicine,” Dr. Tharyan explains.

Evidence from Cochrane listings has actually changed the way interventions are carried out, he adds. In one instance, during the tsunami, a decision was taken to revise counselling strategy for those affected.

The “single, mass de-briefing” technique was suspended after a Cochrane review proved that it had no effect in the short term, rather it could increase the chances of developing Post Traumatic Stress Disorder in the long run. Perhaps, as Dr. Tharyan says, if used well, the Cochrane reviews may just change the way medicine is practised in India.

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