Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Time for a Change
- Ned Hoke OMD,L.Ac. (21 December 2001)
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Britain's gift: a "Medline" of synthesised evidence
- Ian Needleman (21 December 2001)
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Department of Health facilitates free access to social care database
- Mark Watson (21 December 2001)
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Clinical Evidence
- J David Bruce, Bodmin, Cornwall PL30 4AN (24 December 2001)
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Free access to clinical data by Britain
- Pallab Chatterjee (25 December 2001)
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The Commonwealth of Learning
- Adriano PERIS (31 December 2001)
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Multinational funding?
- Fiona McLean (2 January 2002)
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"Free" information
- James S Smeltzer, MD FACOG (3 January 2002)
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In full support of a freely available integrated knowledge service
- Fiona Godlee (8 January 2002)
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In respect for British knightliness
- Takeo Saio, Kawashimada 1067-1, Gotemba, 412-0045, Japan (11 January 2002)
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Long live British generosity
- Padmanabhan Badrinath (25 January 2002)
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BMJ's gift should be to advertise clinical trials …such as the MRC CRASH Trial
- Ian G Roberts (9 February 2002)
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Re: Clinical Evidence
- Philip R Vaughan (8 April 2002)
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Ned Hoke OMD,L.Ac., private practice/Ecological Medicine 95476 USA
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Assuming clinical benefit as the core central value of healthcare I suggest further expansion to this grand scheme of Drs. Smith and Chalmers. Presented as a gift of "what works, what doesn't, what's good science or not, and perhaps why" very many people have come to experience, in very many ways, how modern industrial healthcare lives in constrained paradigms which substantially affect vast numbers of clinical outcomes, both in positive and negative ways. Too big a subject for a brief reply but I suggest Dr. Smith et. al. also invite professionally trained clinical input from responsible sources for inclusion within this synthesis representing various voices of alternative medicine. If indeed the principle of this rich information-age collaboration is genuinely to serve a wide world of healthcare requirement giving searching and thoughtful professional and lay persons access to guidance on the best of functional therapeutics, leaving out first quality alternative healthcare would firmly defeat the claimed objective. I doubt my father's dear friend Lord Arthur Porritt would agree, nor might Sir George Godber, but we have come to another time. An opportune moment, time for a change. |
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Ian Needleman, Lecturer in Periodontology WC1X 8LD
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I would like to commend Richard Smith and Iain Chalmers for this concept. Evidence-based healthcare will never make real progress at the coalface until this initiative is undertaken: 1. The variability in the quality of biomedical research markedly
affects the value of the data to patient care
Let's integrate the excellent initiatives that already exist in healthcare infomatics and make the best available evidence widely available. This will be a leap forwards. |
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Mark Watson, Director of Information Social Care Institute for Excellence (SCIE), 1st Floor, Goldings House, 2 Hays Lane, London SE1 2HB.
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The new Social Care Institute for Excellence (SCIE) began work on 1 October 2001, and announced that access to the highly regarded caredata knowledge base was to be free of charge. This database, developed by the National Institute for Social Work and now transferred to SCIE, was previously available only by subscription. Jacqui Smith, Minister for Health, with responsibility for social care, said "Making caredata available is the first stage in establishing a better knowledge base for management and practice in social care. SCIE will need to work with individuals, networks and organisations to guarantee that their practice takes account of the best available knowledge." I would propose that the cost to the taxpayer of enabling free access to databases of this nature is relatively minimal and more than offset by the benefits that freer access brings. Caredata generated not insubstantial income, but that income came from local authorities and the academic sector budgets, with the result that public money goes round in ever-decreasing circles. |
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J David Bruce, GP locum Polventon, Fletchers Bridge, Bodmin, Cornwall PL30 4AN
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Having read the editorial about the site Clinical Evidence, I was fired with enthusiasm for a valuable resource. I then realized that, as a general practice locum seeing National Health Service patients, I was not eligible for free entry to the site. Although I can see the commercial reasons for this, it does seem to be an anomaly. J D Bruce |
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Pallab Chatterjee, Consultant Paediatrician Kolkata, West Bengal, India, 700030
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Sir, I read with interest your article regarding Britain's gift vis-a-vis USA's (availability of Medline on the net). However, both these cannot be compared. Medline's entire access is free, while the sites that you have suggested in your article all require subscription for any work of substance to be done using them. The medical fraternity all over the globe will highly appreciate Britain's gift to the world in the new millenium if all these can be provided free of cost, just like Medline. Thanking you, Yours sincerely, Dr. Pallab Chatterjee. India. |
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Adriano PERIS, Director of Clinical Anaesthesia Ospedale CAREGGI - Firenze-ITALY
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Dear Sirs, congratulations for your work;the "bmj.com" has been the reference medical website for Physicians practising Anaesthesia in my Department since November 1997. It is a great value for money; you have to consider the fact that CPD is very expensive for Physicians working in Public Hospitals in Italy. The Commonwealth of Physicians is grateful to you for "removing the rubbish that lies in the way of medical knowledge" Sincerely, Adriano PERIS Consultant in Anaestesia and Intensive Care |
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Fiona McLean, Health care information officer British Library, 96 Euston Road, London NW1 2DB
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It would be great to have these resources funded by the UK for worldwide free access. If this doesnt work out, maybe some of the other countries involved in the Cochrane Collaboration could also contribute funding? Maybe on condition its *not* called the Lizzie database (tho I would love it to have this name!) |
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James S Smeltzer, MD FACOG, Consultant, Maternal Fetal Medicine Wellstar Health System, Marietta GA 30060
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The premise of the "Friends of the National Library of Medicine", of which I was a charter member, was that the latest and best medical information should be freely and openly available to all, uncensored. This effort funded the development of Grateful Med as a cost-effective access to this information. The current free internet availability of the BMJ is a true "gift" in that same spirit. Fortunately, thanks to the US government awakening to the enormous potential value of this resource, and to the internet, which makes information requests almost cost-free, this open availability of medical information now extends to most of the medical world and is virtually free. The Cochrane Database is a noble idea, but the tariff for access continues to make it prohibitively impracticable for me to use. The total added value of correct information to a society is proportional to its useful dissemination. I am unsure whether elitism or greed has led Chalmers et al to this choice to restrict access and thereby reduce the value of their work. For myself and the many other physicians who must continue to make up our own minds about the evidence with the help of the NLM Gateway (http://www.nlm.nih.gov/nlmhome.html) and our local medical librarians, I am not sure this has been a bad thing. Here in the US we have a much less elitist attitude towards everything, including information. You can even find our nuclear secrets on the net. Nonetheless, it took a while for the notion that peptic ulcers were caused by bacteria(1) to become the prevalent one, because of an insular view, and because of shakey evidence. This is the inherent danger of the evidence-based approach. The fairly certain and settled evidence that ulcers were caused by glucocorticoids, NSAIDS, stress and disease obscured the fact that most ulcers were caused by microbes. As long as we are looking backwards we will continue to identify new verities only when they hit us in the back of the head - provided we are moving forward. The ultimate temptation becomes to remove that pain by stopping our movement. We can then, like Aristotle, focus on the correct classification of our information so that all will be known. To avoid this fate it would be helpful to increase the cost of access to the database so that it is only accessible to the authors, so the rest of us can continue to muck around. It then, truly becomes a "gift" in the sense a nicotine addiction - raise the price and it hurts you less..... ;^) (1) Inframicrobial etiology of the ulcerous disease. NICOLAU SS, PETRESCU A, ATHANASIU P, SURDAN C. Rev Sci Med (Bucur) 1962;7:177-80. |
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Fiona Godlee, Editorial Director for Medicine BioMed Central and Current Controlled Trials, London W1T 4LB
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Editor, Current Controlled Trials (publisher of the metaRegister of Controlled Trials) fully supports the initiative described by Richard Smith and Iain Chalmers, to create an integrated service consisting of the metaRegister, the Cochrane Database of Systematic Reviews, and Clinical Evidence. We also endorse the call to make this service freely available to all. While the metaRegister is currently free both to users and to those depositing data, we are seeking funds to secure its long term future. Funding from the British government could secure the long term future and further enhancement of all three products, while creating a universally accessible knowledge base for health care that would add greatly to Britain's global prestige. Competing interest: FG is Editorial Director of Current Controlled Trials but has no personal financial interest in it. |
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Takeo Saio, physician Department of Internal medicine, Fuji-Toranomon Orthopedic hospital, Kawashimada 1067-1, Gotemba, 412-0045, Japan
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The editorial written by Richard Smith and Iain Chalmers astonished me because of not only their conceptional framework in deploying evidence-based worldwide healthcare system but also the great tradition of British, noblesse oblige. We Japanese have also proud and brave tradition of Samurai spirit, but yet no such real effective contribution to the global health equity has been accomplished by us. Our country, Japan, has a stagnant economy over the last 10 years and reportedly nearly going into bankruptcy. Even though, I would stress the point that the contribution of my country to establishing worldwide health equity must be strengthened through collaboration with this British initiative. I am neither a politician nor an administrator and even not a opinion leader of Japanese healthcare society. Only a physician. But I will tell our colleagues in Japan that British goverment has humanitarian spirit. God bless you all. SAIO, Takeo MD.
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Padmanabhan Badrinath, Clinical Assistant Professor & Hon Consultant in Preventive Medicine Faculty of Medicine & Health Sciences, UAE University, Al-Ain, UAE
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Dear Editor, I whole heartedly welcome and support your efforts to provide evidence based resources available free through the World Wide Web to health professionals across the globe (1). No doubt, this will benefit hundreds of thousands of professionals from countries which cannot afford to pay for such resources. ____________________________________________________________ Your editorial is timely as there is a move now to move towards preprocessed information for the practice of evidence based medicine (2). As these preprocessed information sources are expensive to compile some one has to pay for it before it reaches the end users (both professionals and to some extent the patients). Great Britain has a long tradition of supporting scholars from developing countries and I should confess that I was one of the beneficiaries of such support, which helped me to complete my Master and doctoral training from Cambridge University, UK in Epidemiology. This would have never been possible without British generosity. ____________________________________________________________ This has continued till to day as I access eBMJ freely every Friday and benefit from the information presented. In this era of exploding information technology if Britain could provide free access to EBM resources this will have a long lasting impact on millions of people all over the globe including patients and their carers and the phrase "Long live British generosity" will echo in the hearts and minds of every citizen of our global village. ____________________________________________________________ References 1) Smith R, Chalmers I. Britain's gift: a "Medline" of synthesised evidence. BMJ 2001; 323: 1437-1438 2) Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes BR. Practitioners of evidence based care. BMJ 2000;320:954-955 ____________________________________________________________ Dr.P.Badrinath MD.,M.Phil.,PhD(Cantab)
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Ian G Roberts, Professor of Epidemiology and Public Health London School of Hygiene and Tropical Medicine
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Editor - Smith and Chalmers imagine the benefits that may result from integrating the Cochrane Library, Clinical Evidence and the metaRegister of Controlled Trials.1 Future doctors wanting to find out about the effectiveness of a particular medical intervention would first search the Cochrane Library and if they found uncertainty they would search the metaRegister of Controlled Trials to see if a relevant clinical trial was underway. They believe that this would substantially increase trial recruitment and thus provide more quickly the answers to some important questions. Their sentiments are noble but naïve. If Smith is serious about promoting recruitment in clinical trials then he should consider using some of the valuable advertising space in the BMJ to actively promote on- going trials and with the same vigour as pharmaceuticals and the products of the BMJ publishing group are advertised. It may hurt the journal's revenue stream but it will benefit patients. The MRC CRASH trial is a large randomised controlled trial of a short -term corticosteroid infusion following head injury (www.crash.lshtm.ac.uk). It aims to recruit 20,000 patients over five years, a small fraction of one percent of the patients admitted to hospitals around the world with head injury each year. In 1997 The Lancet fantasised how publication of protocols of on-going trials would help to recruit new centres.2 The CRASH trial protocol was accepted for publication in 1998 but was buried along with the other protocols in the small print of the author information section of the web-site. BioMed Central was more pro-active by sending an email message to potentially interested collaborators at the same time as publishing the trial protocol, but the impact of a one-off activity like this will be limited.3 There has been uncertainty about the effectiveness of corticosteroids in head injury for the past fifty years.4 The CRASH trial will answer this question. If the BMJ is committed to helping trial recruitment then it should respond positively to this invitation to advertise the MRC CRASH trial in the paper journal and on the web-site. Journal editors have a responsibility to patients to advertise clinical trials. References 1. Smith R, Chalmers R. Britain's gift: a "Medline" of synthesised evidence. BMJ 2001;323:1437-8. 2. McNamee D. Protocol reviews at The Lancet. Lancet 1997;350:6 3. The CRASH Trial Management Group. The CRASH Trial Protocl. BMC Emergency Medicine 2001, 1:1 (11June2001). 4. Alderson P, Roberts I. Corticosteroids in acute traumatic brain injury: a systematic review of randomised trials. BMJ 1997;314:1855-9. |
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Philip R Vaughan, Service Delivery Manager, National Electronic Library for Health NHS Information Authority Aqueous II, Rocky Lane, Birmingham B6 5RQ
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I was saddened to hear that Dr Bruce believed that as a GP locum, he was not entitled to use Clinical Evidence on the National Electronic Library for Health. This is NOT the case; all users working in, or providing services to, the NHS are welcome to use our licensed content (Cochrane Library, Clinical Evidence, EBOC, E-Guidelines and Anatomy-TV). These databases can be accessed via our site either directly through NHSnet, or via a password from pc's not on NHSnet. More information is available at:- http://www.nelh.nhs.uk/home_use.asp thanks Phil Vaughan
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