Volume 177 - Issue 4
EBM in action
Authors: Richard L Prince, Christopher B Del Mar and Paul P Glasziou
Med J Aust 2002; 177 (4): 223-224. || doi: 10.5694/j.1326-5377.2002.tb04742.x
Published online: 19 August 2002
Published online: 19 August 2002
To the Editor: I read with interest the recent correspondence in the Journal from Del Mar and Glasziou.1 Their appeal to one of their critics was to "abandon throwing bricks from the sidelines and join us in trying to help clinicians assess research evidence in [a] timely fashion". More recently, their defence in relying on generalists, rather than experts, to assess the evidence was, somewhat curiously, that "a cat may look at a king".2 In response to these comments, I believe that one of their recent presentations relating to natural remedies for osteoporosis in postmenopausal women3 falls short of current evidence-based medicine requirements. I suspect that this may be because they have no expert in the area they are reviewing to assist them in assessing the data.
An expert would have been able to tell them that their statement "Although no trials specifically compared 'just walking' with 'exercise in the gym', there was reasonable evidence supporting the beneficial role of walking in this patient group"3 was incorrect.4 Furthermore, an expert would have known that the fundamental biological basis of the effect of exercise on the skeleton relates to the induction of significant strains within the skeleton.5 Because these effects are site-specific and load-dependent, the physiological mechanisms differ from those involved in cardiovascular health. Secondly, an expert in the area may have pointed out that the principal constituent of codliver oil that affects the skeleton is vitamin D. To claim that there were no benefits on bone mineral density or fracture from vitamin D would not be supported by current data.6
Keeping up-to-date in medical practice has become more difficult as the information base expands. Performing an Internet search may be adequate for answering some patient-based specific questions, but, in general, reading an up-to-date review is probably better. Presenting the results of a rapidly performed, deficient analysis in an internationally renowned journal is another thing entirely.
References
- Del Mar CB, Glasziou PP. EBM in action: is laser treatment effective and safe for musculoskeletal pain? [letter]. Med J Aust 2002; 176: 195. <eMJA full text>
- Del Mar CB, Glasziou PP. Safety of hormone replacement therapy after mastectomy. Med J Aust 2002; 176: 618-620. <eMJA full text>
- Del Mar CB, Glasziou PP, Spinks AB, Sanders SL. Natural remedies for osteoporosis in postmenopausal women. Med J Aust 2002; 176: 182-183. <eMJA full text>
- Kerr D, Ackland T, Maslen B, et al. Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res 2001; 16(1): 175-181. BGBEIGIH
- Kerr D, Morton A, Dick I, Prince R. Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res 1996; 11: 218-225. BGBICBEI
- Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637-1642.
- McAlister FA, Clark HD, van Walraven C, et al. The medical review article revisited: has the science improved? Ann Intern Med 1999; 131: 947-951. r1
- Australasian Cochrane Centre. Available at: <http://www.cochrane.org.au/>. Link updated August 2005.
- Del Mar CB, Glasziou PP, Spinks AB, Sanders SL. Natural remedies for osteoporosis in postmenopausal women. Med J Aust 2002; 176: 182-183.<eMJA full text>