Trip Database Blog

A nice blog post from the FT (click here) highlights an article that Iain Chalmers and Silvio Garattini have recently published in the BMJ (click here). In it they propose 4 suggestions to improve the way the pharma industry carries out research, they are:

1) Patients to be involved in shaping the research agenda – in other words, making sure research questions have resonance in real life and real-world situations

2) Legal requirements for research to be published, including trial protocols, by all (mandatory publication of trial data has had legal backing in the US since late 2007; no such protection for patients currently exists in the UK)

3) Independent evaluation of drugs. As the paper says: “The monopoly that the drugs industry has in evaluating its own products, and the secrecy surrounding this process, leads to biased evidence that is currently only rarely questioned by independent studies.”

4) A requirement to demonstrate “added value” for all new drugs – is this drug better than the current best drug treatment, or does it benefit in addition to it, and is it better than non-drug treatments? Too often, trials are done comparing a new treatment to placebo where there is a known intervention which is better than placebo. This means that uncertainty about how to use it best persists.

Laika’s blog is a wonderful source of commentary on EBM and the wider role of a medical/clinical librarian. Her blog includes two recent posts, the first by herself and the second is a guest post:

• How Evidence Based is UpToDate really?
• Evidence Based Medicine: The Facebook of Medicine?

I highly recommend them both!

A great post that I heartily recommend – Between a rock and a hard place: inside professional P2P healthcare communities. I liked it so much I added a big comment on it! In reading it I’d also recommend looking at the medical economics article highlighted in first sentence (Behind doctors’ social networking websites).

A number of bloggers have highlighted the ‘sort of’ end (as of yesterday) of the NLH:

• Bye bye National Library for Health
• NHS Evidence
• Farewell then NLH

Over the years TRIP worked on a number of projects, first with the NeLH and then the NLH. Initially we provided a search solution, various bits of project work and finally on the Q&A service.

I’m wondering if the NLH is (or will be) considered a success or not. I remember, near the start of the NeLH, I saw Muir Gray discuss the aims of the site. He said something like people will have access to top quality material within 3 clicks. I don’t believe it came close to this. I also think the view of the NLH will be shaped by the success or not of NHS Evidence.

What does concern me about NHS Evidence is that it’s a search solution using accredited sources of information. I return to the theme of what do the users want? Do the people in NHS Evidence understand why people search for information?

Probably the most likely reason for a clinician to search NHS Evidence is because the have a clinical question. In an ideal world, if you have a question which would you prefer:

• A list of 10-20 hyerlinks to accredited documents
• An answer using the best available evidence

If you’re a busy clinician and you have a choice of asking a colleague (as we know most clinicians do) or searching and trying to find the answer from multiple documents human nature suggests the former is more likely. And most people will acknowledge the problematic nature of search.

This is not about me wishing to reinstate the Q&A service, this is about wanting to support clinicians to practice evidence-based healthcare. Give clinicians the answers they want, make their lives easier. The more barriers you place in the way of practicing with ‘best evidence’ the less likely it is to be practiced.

By the end of this month NHS Evidence will have launched with their super-duper new search engine. I genuinely hope they introduce some innovative features that we (at TRIP) can learn from. However, search is only part of the solution. From my perspective the sooner they realise that the better.

In saying farewell to the NeLH/NLH one name has gone unmentioned – Ben Toth. He was instrumental in setting up the NeLH and he achieved great things.