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Evidence in Upheaval
Incorporating Observational Data Into Clinical Practice
Arch Intern Med. 2002;162:249-254.
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You cannot make a pig grow by weighing him.
Irish proverb1
THE EVIDENCE-BASED medicine movement has largely met with success. However,
its emphasis on the randomized clinical trial may have unintentionally led
to a depreciation and misunderstanding of the role of the observational study
in the diagnosis, prevention, and treatment of illness in everyday clinical
encounters. Published studies do modify clinical practice; no matter how rigorous,
published data are only a part of the process that clinicians use to make
clinical decisions. A complex system of "beliefs" guides physicians through
this process. These attitudes may be modified by newer evidence, both observational
and experimental, but only in association with other influential, "non–evidence-based"
factors, such as personal and societal values.
The current movement toward practicing a form of medicine that is evidence
based is not new, since clinicians have traditionally incorporated important
published research findings into clinical practice.2
What is . . . [Full Text of this Article] CLINICAL STUDIES, PRIOR BELIEF SYSTEMS, AND THE "WILLINGNESS TO PLEASE"
THE CLINICAL UTILITY OF OBSERVATIONAL STUDIES
OPTIMIZING THE COMPLEMENTARY RELATIONSHIP BETWEEN OBSERVATIONAL STUDIES
AND RCTs
CRITERIA FOR THE "PROVISIONAL ACCEPTANCE" OF OBSERVATIONAL DATA INTO
CLINICAL PRACTICE
CONCLUSIONS
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