In reply: Ethics and evidence-based medicine

In reply: Anaf seems to have missed our point that the choice by Leeder and Rychetnik1 of mental health as an area relatively devoid of good quality evidence was a poor one — quality research has revealed mental health as an area of considerable need, and mental illness as a significant component of the global burden of disease. Despite the fact that evidence is often more difficult to obtain within the mental health area, much evidence exists — for example, the Cochrane Collaboration Depression, Anxiety and Neurosis Group has 11 500 controlled trials in its registry, and the Drugs and Alcohol Group has 3314. Anaf would agree with us here (on the basis of his assertions about the quality of the particular evidence he alludes to).

On the narrower issue of the evidence base for long-term intensive psychiatric treatment, Anaf implies that this was ignored or distorted by the then Health Minister in deciding to amend the Medicare Benefits Schedule. We agree that EBM (and sound research) can be politically misused (as can any product of science), but that is no basis for rejecting EBM. Political misuse is a political mischief, not a failing in the particular instrument being misused. EBM itself is frequently blamed for all sorts of problems in health service, whereas, to use Anaf's example, the relative quality of the evidence for short or long term psychiatric treatment is a contingent matter for development and deliberation within and outside the psychiatric research community.