In The Reasoner: Statins

The ongoing debate over the use of statins has been covered extensively in the mainstream media. Recently, Sally Davies, the chief medical officer, has expressed concern that the lack of resolution to debates such as this is damaging public confidence in medicine. In response, Davies concluded that what is needed is “an authoritative independent report looking at how society should judge the safety and efficacy of drugs as an intervention.” As a result, the Academy of Medical Sciences has begun a working group project on Evaluating evidence. The aim of the project is to “explore how evidence that originates from different sources (e.g. randomised clinical trials and observational data) are used to make decisions about the safety and efficacy of drugs and medical interventions.”

More recently, in a BMJ editorial, Ben Goldacre and Carl Heneghan have expressed concern that this working group project may suffer from a lack of ambition, at a time when medicine has a real opportunity to effect necessary changes in how evidence in medicine is evaluated. They conclude:

“The public is increasingly aware of the shortcomings we collectively tolerate in the evidence base for clinical practice. We now have the opportunity to use public frustration as fuel to update our implementation of evidence based medicine in the light of new technology and get our house in order.”

They argue that it would be recklessly backward looking to only focus on the interpretation of inadequate existing data instead of making real fixes to evidence-based medicine. In addition, they provide a number of proposals for how to fix evidence-based medicine, e.g., addressing publication bias, the costs of independent trials, and encouraging better evidence.

In the meantime, another Evaluating evidence in medicine project is ongoing, with the project kick-off workshop taking place last month. Among other talks, PhyllisIllari (UCL) spoke about dealing with fears about mechanisms, Mike Kelly (Cambridge) spoke about the role of biological and social mechanisms in the development of guidelines, and Christian Wallmann (Kent) spoke about the reference class problem.

The Reasoner is a monthly digest highlighting exciting new research on reasoning, inference and method broadly construed. It is interdisciplinary, covering research in, e.g., philosophy, logic, AI, statistics, cognitive science, law, psychology, mathematics and the sciences. Each month, there is a column on Evidence-Based Medicine.┬áThis month’s issue includes the following:

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