Britain's gift: a “Medline” of synthesised evidence
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7327.1437 (Published 22 December 2001) Cite this as: BMJ 2001;323:1437All rapid responses
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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.
Competing interests: No competing interests
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)
Clinical Assistant Professor & Hon Consultant In Prev Med,
Faculty of Medicine & Health Sciences, PO Box 17666,
Al-Ain, UAE.
Competing interests: No competing interests
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.
Department of Internal medicine, Fuji-Toranomon
Orthopedic Hospital, Kawashimada 1067-1, Gotemba, 412-0045, Japan
e-mail: saio@ppp.bekkoame.ne.jp
Competing interests: No competing interests
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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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!)
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
Re: Clinical Evidence
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
Service Delivery Manager
National Electronic Library for Health
Competing interests: No competing interests