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Evidence-based medicine: how COVID can drive positive change

2021; Nature Portfolio; Volume: 593; Issue: 7858 Linguagem: Inglês

10.1038/d41586-021-01255-w

1476-4687

Health Policy Implementation Science

The fundamental principles of evidencebased medicine stand firm; it's the processes that need to evolve."commission of thought leaders to assess how best to supply evidence to address social challenges, such as climate change and inequality, that go well beyond health.This group has a unique opportunity to refine, re-imagine and re-engineer processes for the generation, supply and use of research-based evidence and so ensure that our future world is one better informed by rationality and fact.The fundamental principles of evidence-based medicine stand firm; it's the processes that need to evolve.When the Cochrane Collaboration was formed, its founders knew that reviews must be regularly updated with the latest research.But, in practice, this is often difficult because of the laborious nature of the literature searches and data synthesis required.New methods can help.Last year, a group at the Institute for Evidence-Based Healthcare at Bond University in Gold Coast, Australia, published a full systematic review completed in two weeks, using a skilled team and automated tools to search for and extract data ( J. Clark et al.J. Clin.Epidemiol.121, 81-90; 2020).And during the pandemic, scientists collaborated to quickly produce 'living' systematic reviews on potential COVID-19 therapies, which are updated as new studies come out.Researchers must now evaluate the best methods for generating fast reviews and living ones, as well as deciding on which topics it's worth investing in them.The pandemic has shown that large, coordinated clinical trials that span hospitals and test multiple treatments against one condition offer an excellent way to include sufficient numbers of patients to provide firm conclusions about what works.The United Kingdom's RECOVERY trial and the WHO's SOLIDARITY trial are exemplars of this approach.It would be a powerful legacy of the pandemic if this model were widely adopted on an ongoing basis to provide the numbers necessary for trials in many health conditions.This would have the added bonus of involving many doctors and researchers, helping to educate them in what a well-designed trial looks like -and so ensuring that fewer poorly designed ones are done.Cochrane and the other organizers of the October meeting say they hope to take any recommendations that emerge to the World Health Assembly in May 2022, to discuss with member states.It's important for countries to demand -and fund -changes.All these efforts must include diverse perspectives from patients, citizens and policymakers.This will help to ensure that evidence is equitably available, and that research and reviews address the needs of communities worldwide, rather than just earning scientists more career-boosting papers.Getting there will require organizations such as Cochrane to take a hard look at their processes and be willing to change what they do.There is a danger that everyone will be so keen to move on and forget the trauma of the pandemic that we won't take time to reflect and improve.But Archie Cochrane's 50-year-old plea that decisions be based on rigorous evidence is more important than ever, and, tired though everyone is, we need to put in the work now so that we can deliver better, quicker evidence next time around.