Reviving Cochrane’s contribution to evidence-based medicine: bridging the gap between evidence of efficacy and evidence of effectiveness and cost-effectiveness

Jack E. James*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Throughout the quarter century since the advent of evidence-based medicine (EBM), medical research has prioritized ‘efficacy’ (i.e. internal validity) using randomized controlled trials. EBM has consistently neglected ‘effectiveness’ and ‘cost-effectiveness’, identified in the pioneering work of Archie Cochrane as essential for establishing the external (i.e. clinical) validity of health care interventions. Neither Cochrane nor other early pioneers appear to have foreseen the extent to which EBM would be appropriated by the pharmaceutical and medical devices industries, which are responsible for extensive biases in clinical research due to selective reporting, exaggeration of benefits, minimization of risks, and misrepresentation of data. The promise of EBM to effect transformational change in health care will remain unfulfilled until (i) studies of effectiveness and cost-effectiveness are pursued with some of the same fervour that previously succeeded in elevating the status of the randomized controlled trial, and (ii) ways are found to defeat threats to scientific integrity posed by commercial conflicts of interest.

Original languageEnglish
Pages (from-to)617-621
Number of pages5
JournalEuropean Journal of Clinical Investigation
Volume47
Issue number9
DOIs
Publication statusPublished - Sep 2017

Bibliographical note

Publisher Copyright:
© 2017 Stichting European Society for Clinical Investigation Journal Foundation

Other keywords

  • Archie Cochrane
  • commercial conflict of interests
  • cost-effectiveness
  • effectiveness
  • efficacy
  • evidence-based medicine
  • randomized controlled trials

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