16471 - Evidence Based Medicine The Hierarchy of Evidence...

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Evidence Based Medicine Evidence Based Medicine The Hierarchy of Evidence Ora Paltiel, May 29, 2004
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What is evidence? Definition What is evidence? Definition That which- 1. Serves to prove or disprove something; that which is used for demonstrating the truth or falsity of something, support, proof 2. Serves as a ground for knowing something with certainty or for believing something with conviction 3. Is properly presented before a court as a means of establishing or disproving something alleged or presumed
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Forms of evidence Why do we need to be convinced? Does A cause B?/ Is A associated with B? PREVENTION- which preventive measures are worthwhile? THERAPEUTICS can the treatment work ? ( efficacy ) does the treatment work? ( effectiveness ) is it appropriate for my patient?
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WHY are clinical trials needed? WHY are clinical trials needed? “Given the uncertain knowledge about disease course and the usual large variations in biologic measures, it is often difficult to say on the basis of uncontrolled clinical observation whether a new treatment has made a difference to outcome, and if it has, what the magnitude is.”
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Ideal clinical trial is one that is randomized and double-blind Consequences of not conducting appropriate clinical trials at the proper time can be serious and costly gastric freezing Fetal cell implants in Parkinsonism HRT
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WHEN are clinical trials needed? WHEN are clinical trials needed? Before a therapy becomes standard After 10s 100s 1000s or millions have been exposed? Digitalis 200 years Estrogens 50 years The field of therapeutics is replete with examples of new modalities that were taken up with enthusiasm and proved worthless only after they had resulted in many years of futile cost and suffering
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This note was uploaded on 02/23/2012 for the course PHARM 290 taught by Professor Staff during the Fall '10 term at Rutgers.

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16471 - Evidence Based Medicine The Hierarchy of Evidence...

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