Effectiveness And Efficiency: Random Reflections on Health Services
Effectiveness And Efficiency: Random Reflections on Health Services Books
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Originally published in 1972, Archie Cochrane’s classic text has had a profound influence on the do of medicine and on the evaluation of medical interventions. He was the first to set out clearly the vital importance of randomised controlled trials (RCTs) in assessing the effectiveness of treatments, and his work led directly to the setting-up of the Cochrane Collaboration, now a world-wide endeavour dedicated to tracking down, evaluating and synthesising RCTs in all areas of medicine. The thought contained in this book is as relevant to clinicians, healthcare managers and policy-makers now as it was in the 1970s.
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From Alexander Cochrane, the Englishman who called for and implemented standardized, periodical, randomized controlled trials (RCTs), this classic 1972 text laid the foundation for the worldwide task of the Cochrane Collaboration: “preparing, maintaining and disseminating systematic reviews of the effects of health care”. “Evidence-based medicine” (EBM) in todays’s jargon. This updated edition has a link of new essays that detail how such higher scientific standards for clinical medicine, detailed here and in the journals and centers of evidence based medicine this work directly inspired, together with the health consumers movement, have empowered healthcare consumers and providers alike.
Effectiveness and efficiency is simply the necessity for clinicians (and demanding healthcare consumers!) to learn to efficiently formulate an answerable clinical question and to research the latest peer-reviewed medical literature for an applicable resolution by evaluating the BEST available evidence for its validity, reliability, and relevance for the specific individual concerned. Finding a “Cochrane review” is the “gold standard.”
A recently published book/CD ROM package that depends on Cochrane’s revolutionary work is the authoritative adaptation of the highly well loved Journal of the American Medical Family 25-part run [1992-2000], edited by Dr. Gordon Guyatt, the Users’ Guide to the Medical Literature: Essentials of Evidence-Based Clinical Do.
Another, equally excellent, fruit from Cochrane is the brilliant and well loved text/CD package, Evidence-Based Medicine: How to Do and Teach EBM by David L. Sackett, Sharon E. Straus, W. Scott Richardson, Rosenberg.
Cochrane and his posthumous collaborators will exchange the way you reckon of medicine and the demands you make on it. Even as medicine has everlastingly been pragmatic by necessity, now, at last, medical research is matter-of-fact for all non-trivial clinical questions.
Not for doctors only: this is excellent, clear analytical thought that anyone can know and apply. Even doctors. For dedicated, highly motivated healthcare consumers, these latter two applied guides to EBM sure beat surfing the Internet randomly without a roadmap to quality healthcare in rank.
Cochrane’s Effectiveness and Efficiency remains the compass.
Rating: 5 / 5
Archie Cochrane was a greatly underappreciated figure in the
evolution of the British healthcare system. Given that this system
is the least pricey (about 7.7% of Yucky Domestic Product) and
among the most effective (measured by average longevity) even as
covering 100% of its citizenry, you might reckon that Cochrane would
be in line for sainthood. He certainly deserves to be. The belated
recognition of his contributions is best manifest by the Cochrane
Collaborative and Library which attempts to result in together ALL published
clinical trials and, where numbers allow, provide authoritative
meta-analyses. Why has the NIH not supported this endeavor?
Cochrane’s insights were two:
- There will never be enough money to provide all the diagnostic
and therapeutic procedures that doctors can invent; and
- Given this, it is morally imperative that we test and validate
how we spend the monies derived from (privately or publicly)
socialized funds to assure that morbidity and/or mortality are
improved.
The average citizen likely assumes that the doctor would not urge
unproven or disproven tests or treatments. He is incorrect. Most of what
is done to patients is only based on theory, or perhaps surrogate measures of the real clinical outcomes. Cochrane didn’t live to
see the accumulation of evidence on this question, but I suspect he
would have howled at Brownlee’s “Overtreated” or Abramson’s “Overdosed America” – compendiums of the failings of “accepted” therapies – and fantastic companion volumes.
Cochrane’s text, based on an invited address from 1972, is not as focussed as I’d like, but it is “the turning top” in the struggle to
make Evidenced-Based Medicine – a long overdue task. You may possibly do
worse than travel this line of thought with this prescient figure.
Rating: 5 / 5
This book is to be reissued in March 1999 in Britain and published by Nuffield Trust with additional material of importance since the book was first published in 1972.
Rating: 5 / 5