The problem of evidence- based medicine in

Document Sample
The problem of evidence- based medicine in Powered By Docstoc

pose a serious threat to the privacy of                licensing bodies (colleges) — it’s time                By highlighting this issue of poor
individual research subjects. In the ab-               to clean up our act.                                research culture, we hope to contribute
sence of clear evidence that the publica-                  Here is my proposal. If a physician             to increased awareness among those
tion of anonymized data sets would de-                 has a valid medical licence to practise             who read journals and who can bring
ter the publication of flawed or                       in any province or territory of Canada,             about positive change.
fraudulent research, and in the absence                along with a clean bill of conduct and
of a clear standard for anonymizing                    CMPA coverage, he or she should be al-              Ahmad A. Sabri
data sets to ensure that individuals can-              lowed to do locums anywhere in                      Physician
not be re-identified, alternative means                Canada without further licensing re-                Faisalabad, Pakistan
of validating research findings should                 quirements.                                         Muhammad Ahad Qayyum
be considered.                                                                                             Physician
                                                       Stephen Sullivan                                    Mayo Hospital Lahore
Ann Cavoukian                                          Victoria, BC                                        Lahore, Pakistan
Information and Privacy                                DOI:10.1503/cmaj.1060081
 Commissioner of Ontario
Toronto, Ont.                                                                                              REFERENCES
                                                                                                           1.   Alexander GC, Sayla MA, Holmes HM, et al. Priori-
                                                       The problem of evidence-                                 tizing and stopping prescription medicines. CMAJ
REFERENCE                                                                                                  2.   Sadana R, D’Souza C, Hyder AA, et al. Importance
1.   Are journals doing enough to prevent fraudulent
                                                       based medicine in                                        of health research in South Asia. BMJ 2004;
     publication? [editorial]. CMAJ 2006;174(4):431.

                                                       developing countries                                3.   Aslam F, Qayyum MA, Mahmud H, et al. Attitudes
                                                                                                                and practices of post graduate medical trainees to-
                                                                                                                wards research – a snapshot from Faisalabad. J Pak
                                                                                                                Med Assoc 2004;54:534-6.
                                                       In a recent article, Caleb Alexander and            4.   Aslam F, Shakir M, Qayyum MA. Why medical stu-
One country, too many                                  associates1 elucidate the issue of priori-               dents are crucial to the future of research in South
                                                                                                                Asia. PLoS Med 2005;2(11):e322.
                                                       tizing and stopping prescription medi-
licensing bodies                                       cines, pointing to a lack of data on the            DOI:10.1503/cmaj.1060108
                                                       safety and optimal means of discontin-
Having worked in the medical profes-                   uing drugs.1 This may be the core prob-
sion in both Canada and abroad, I have                 lem in developed countries, but the sit-            Private health insurance
come to the conclusion that Canada,                    uation is altogether different in
the second-largest country in the world                developing countries, where a poor re-              needs consent
(in geographic terms), is too small to                 search culture is the biggest obstacle to
have separate medical licensing boards                 the promotion of evidence-based medi-               Loreen Pindera1 describes the Quebec
for each province and territory.                       cine and in turn to the prioritization              health ministry’s recently released
    Let me explain. Prospective medical                and discontinuation of prescription                 white paper, which recommends pri-
students in Canada compete for all the                 medicines.                                          vate health insurance as a means of re-
first-year medical school slots across                     The utilization and production of re-           ducing waiting time for “elective hip,
Canada. Of those accepted, the vast ma-                search, along with human and institu-               knee and cataract surgeries, and to can-
jority finish medical school by writing                tional development, are 2 important                 cer-related surgeries.”2 According to
the examinations for the Licentiate of                 components of health research.2 With-               the white paper, “This is the first step:
the Medical Council of Canada (LMCC).                  out these, it is very difficult to practise         the mechanism could be extended to
They then compete for the available in-                evidence-based medicine.                            other types of hospital services. . . .”2
ternship positions, and many go on to                      The utilization of research, which is              However, the Romanow Commis-
do advanced training, eventually writing               the backbone of evidence-based medi-                sion “heard from Canadians through
the Canada-wide examinations of the                    cine, is in a terrible state in developing          the Citizens’ Dialogue and other con-
Royal College of Physicians and Sur-                   countries. A recent study conducted in              sultations [that] the large majority of
geons of Canada (RCPSC).                               a hospital in Pakistan found that only              Canadians do not want to see change in
    The net result is a pool of hundreds,              20% of residents read medical journals              the single-payer insurance principle for
perhaps thousands, of highly qualified                 monthly, only 12% had ever written for              core hospital and physician services.”3
Canadian physicians who might like to                  medical journal publication, and 12%                Given this evidence of citizens’ resist-
practise or do locums in some of the                   had never read a medical journal.3                  ance to changes such as those pro-
more remote areas of our vast country.                     The state of the production of re-              posed for Quebec and to ensure respect
But they have to get a licence for each                search is also not encouraging. In all              for the autonomous choices and prefer-
province or territory where they might                 disciplines of science and technology,              ences of Quebeckers, it seems to me
want to do a locum.                                    India and Pakistan combined have 208                that any proposed changes in hospital
    One country, one LMCC credential,                  researchers per million citizens; the               and physician care must have explicit
one RCPSC, and one Canadian Medical                    comparable figure for the United States             “informed consent” from the public.
Protective Association (CMPA), but 13                  is 4526 researchers per million.4                      Moreover, the method of consulta-

                                                          CMAJ    •   July 4, 2006   •   175(1)   |   62