We recently produced another video series as part of our pathways to impact. Like Evidence-based medicine (EBM) itself, this production has its own backstory which is certainly worth telling.
The Science and Technology Studies (STS) Department at UCL run a series of summer studentships. These involve hiring students to help on different of staff-led research projects happening over the summer, ranging from archival work and publication writing to policy analysis and filmmaking. EBM+ recruited a group of students as part of our own EBM+ video production studentship. The students filmed at various locations around both UCL and the University of Kent – the two host institutions of the Evaluating Evidence in Medicine (EEiM) project (brand name: EBM+).
This was a student-led project supervised by Bex Coates (a STS teaching fellow running the STS ‘Science and Film Production’ course), with the support of Dr. Brendan Clarke and me (Charlie). The STS department also provides excellent facilities and equipment for film and podcast production. In the end we recruited 5 students: Ilan Goodman, Sam Button, Charlotte Holtum, Kate Balding and James McGilligan – all of whom did a superb job.
Our previous videos were intended to be helpful explainers for some of the key philosophical and methodological issues we aim to resolve. Whereas this year, the students set out to produce a documentary-style series. We wanted to delve a bit deeper and trace the recent history of EBM and how it has developed into the practice we see today. The series is structured like so:
We’ve all heard arguments of how EBM was really conceived in Ancient Egypt circa. 2000 B.C. or with Avicenna from about 1020 A.D.. Nonetheless, we decided to start around the 1990s. This, by and large, marks the advent of Randomised Controlled Trails (RCTs) as we know them today, recognised as an essential tool for determining the safety and efficacy of a drug or treatment, rather than relying on spurious claims and poor observational studies – both containing lots of biases and uncontrolled variables. Therefore, the series begins with a story of hope and medical revolution.
This episode investigated the centrality of clinical trials to the approach of EBM, examining how this method of gathering evidence has become so privileged through evidential norms and exploring some potential downsides to the methodology pyramid (no pun intended). Ilan Goodman took the lead here, talking to philosophers and heading over to NICE headquarters to shed light on possible areas of improvement for EBM and clinical trials, such as the problem of external validity.
Evidence-based medicine as a movement is by no means done and dusted. It is dynamic – constantly changing and adapting to new research and guidelines which subsequently translate into clinical practice. This final episode rounds off the series by talking to groups and organisations at the forefront of this movement who are seeking to change how different methodologies are employed. This approach is based on the belief that human beings are incredibly diverse and, thus, we must produce a sufficient plurality of evidence to inform decisions and treatments to meet the needs of individual patients.
Just like Star Wars (?)
For the ‘science fantasy’ fans among you – when I was thinking about this blog, I couldn’t help but liken this series’ structure (very loosely) to the original Star Wars trilogy (bear with me, please). It starts with EBM as the new hope for assessing efficacy and safety. Then, the empire (well, not quite) strikes back as we realise that, whilst incredibly useful for clinical research, RCTs are fallible in various ways and can’t provide all the answers. And finally, we have the return of the Jedi (yes, in this scenario organisations like EBM+, CauseHealth, NICE and IARC are Jedi’s, sort of) who propose new and innovative methodologies for evaluating different kinds of evidence in medicine in order to improve health policy and clinical decisions. Importantly, and unlike Star Wars, we hope these videos can be seen as either a trilogy – i.e one leading onto the next – or helpful in isolation if, for instance, you only wish to find out how EBM recently came into being.
Tips for filmmakers
To end normatively (as philosophers tend to do), I thought to leave you with a few quick tips based on what we learned from our experience making this series – some quite general, some very specific to filmmaking.
– Communication: Set up lots of channels for communication and use them constantly. A project like this requires everyone to know their specific roles and tasks at all times.
– Delegation: Speaking of roles, be sure to delegate efficiently. Play to strengths and distribute work evenly.
– Preparation: Have a checklist to make sure you always have the right kit. There’s nothing worse than setting up to film and realising you forgot a reflector, microphone or even camera (it can happen…). Also, try to send interviewees some questions (or at least something!) before their interview.
– Bring snacks: This is crucial. On long filming days, the crew can forget to eat. Keep fuelled up with a variety of snacks and treats.
I would also like to take this opportunity to thank our interviewees including EBM+ project members: Prof. Jon Williamson, Dr. Brendan Clarke, Dr. Federica Russo, Prof. Mike Kelly (NICE) and Dr. Kurt Straif (IARC), as well as Prof. Jeffrey Aronson from The Centre for EBM of (CEBM) at Oxford University.
Finally, I hope you enjoy the videos! Please watch, like, share and stay tuned for more EBM+ news coming soon.