Evidence Live 2015 took place at the Oxford University Examination Schools on two surprisingly sunny days in April. There were lots of fantastic talks from a range of speakers providing plenty of food for thought and lively debate. Here’s a summary of what I took away from the conference:
“The right evidence for this patient”
Or as Trish Greenhalgh put it, “Is the management of this patient in these circumstances an appropriate (“real”) or inappropriate (“rubbish”) application of the principles of EBM?”. Iona Heath echoed this sentiment, “Evidence from science is essential, but not sufficient when dealing with individual patients” We therefore need to practice patient-focused individualisation of the evidence, and that means we need more work on the external validity of studies. By doing so we may find that for some things we don’t need much more evidence and that, as Trish put it, “more research isn’t needed”. Richard Peto spoke out against excessive and spurious subgroup analyses, stating that “virtually all subgroup analyses are rubbish”. We should be wary of their findings, particularly when the treatment effect is small. It also means that all clinicians need to be able to appraise evidence. To help with this, Rod Jackson has developed the GATE tool for critical appraisal, which – if you haven’t heard about it- is worth looking in to (www.epiq.co.za). It can be used for any study design; in fact Rod offered £100 to anyone who could come up with a study design where the GATE framework could not be used….
“We have changed the world”
A session on the All Trials campaign with Ben Goldacre, Carl Heneghan, Iain Chalmers and Sile Lane (Sense about Science) opened with this extraordinary statement. To date, about 540 organisations and 83 000 people have signed up to the AllTrials campaign; if you haven’t already, I would encourage you to do so as well. Partly in response to pressure from the campaign – and coincidentally on the day this session was held – the WHO published a Statement on Public Disclosure of Clinical Trials Results . It contained the following strong statements: (1) results from clinical trials should be publicly reported within 12 months of the trial’s end; (2) results from previously unpublished trials should be made publicly available; and (3) calls on organisations and governments to implement measures to achieve this. Carl presented work he is involved in, auditing the registration and publication of clinical trials undertaken in Oxford as part of the NIHR Biomedical Research Centre and Unit. He called this “getting our house in order” and challenged delegates to go back to their institutions and to do the same too.
Delegates were challenged to come with a “dangerous idea” – an idea that was daring, because it actually might work! Some very interesting suggestions came up here, have a look for yourself on the BMJ youtube channel and do let us know about your own “dangerous ideas” for EBM.
And lastly, I have to briefly mention diagnostic studies. Patrick Bossuyt likened mastering the 2×2 table to Judo…Is it really that tough? But beyond the numbers, he reminded us that, “diagnosis is not an end in itself; the ultimate value is the difference in health outcomes resulting from the test”.
Overall, compared to the previous Evidence Live conference held in 2013, there was a shift away from merely focusing on issues such as study flaws and lack of access to trial information towards thinking about how to implement evidence into practice for the benefit of individual patients. Planning is already underway for the next Evidence Live which will be held in Oxford in June 2016. We do hope to see you there!