EBM in action

In reply: We agree with Prince that expertise is needed. The only question is, expertise in what? If we rely on experts in the content area, we are subject to error from ignoring studies that do not fit the expert's view or from an overemphasis on studies familiar to the expert.1 On the other hand, if we rely on experts in systematic reviews, we are likely make other errors, especially errors of omission, because we do not know the content area so well.

Perhaps what we need is a marrying of the two. First, experts should learn the business of evidence-based medicine (EBM). It should be part of the training of specialists and general practitioners, as well as medical students. In addition, the Australasian Cochrane Centre runs Australia-wide courses in preparing and interpreting systematic reviews.2 Second, we should find a content expert to assist any review being undertaken (and, indeed, we try to do this when writing systematic Cochrane reviews).

But when we need to respond rapidly to clinicians' and our own questions, there is not time to consult experts for each one. (The doctor in question3 asked five rather separate questions, of which Prince addresses only two.) Instead, we try to do exactly what Prince has suggested: we first look for an up-to-date review (a systematic review, to avoid bias),1 and, in the absence of one of those, proceed with weaker levels of evidence progressively down a cascade. And that is exactly what we did in this case.3

The purpose of our rapid search service is to provide, as quickly as possible, the best available evidence to assist a doctor help a patient — "EBM in action". The five meta-analyses we identified3 did not include your references. We do not, and do not claim to, offer the last word in a very complicated area of clinical practice.