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What is Evidence-Based Medicine?

Carl Heneghan
Last edited 7th June 2009
Only last week, Paul Glasziou alerted me to an editorial by David Sackett on 'Evidence-Based Medicine what is and what it isn’t' [1] which had been cited as the second most accessed paper on the BMJ website. I guess this wouldn’t be of interest until you realise the article is 13 years old - published in 1996. The major contribution of this paper is the classic definition of EBM: ‘Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’.

The promise of the PolyPill

Ami Banerjee
Last edited 10th June 2009
Cardiovascular disease (CVD) causes more mortality and morbidity than any other disease in both rich countries and poor countries [1]. The risk factors have been well-known for 50 years, but the optimal prevention strategy is still elusive. Primary prevention treats individuals before they have a heart attack, whereas secondary prevention focuses on individuals who have had a heart attack. Several classes of drugs treat cardiovascular risk factors, demonstrating benefits in both primary and secondary prevention [2]. Many of these drugs are off-patent, and therefore cheap. Six years ago, Wald and Law hypothesised that a “Polypill”, containing three anti-hypertensives, folic acid, simvastatin and aspirin, could reduce the rates of CVD by over 80%, if all adults over the age of 55 years took it [3]. This week the Lancet published the first ever trial of such a Polypill [4, 5].

The benefits of an open heart

Ami Banerjee
Last edited 10th June 2009
Myocardial infarction (MI) results from a blockage in one or more of the coronary arteries and represents the largest single cause of death worldwide [1]. Even before the introduction of coronary-artery bypass grafting (CABG) in 1968, the focus of treatment and research was opening the blocked artery. Percutaneous coronary intervention (PCI) was first used in 1977, and includes angioplasty, bare-metal stents and more recently, drug-eluting stents (DES). Heart surgeons and cardiologists have argued for the last 30 years over the best way to open up coronary arteries.

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