I have spent much of this year mulling over the implications of having a good evidence base before making a specific claim. And, when it comes to proof, the so-called ‘pyramid’ approach with randomised controlled trials at the apex is difficult to argue against.
That said, it is still worth considering other approaches without necessarily giving credence to those wishing to offer biased or corrupted views. I have heard quite a few respected authorities arguing that, particularly when looking at research where the outcome is to some extent influenced by human foibles and frailties, the RCT approach might not be as easily applied. Furthermore, there is always the issue of denying somebody something that may help until the burden of proof has been satisfied. At what point is that decision to be made? As long as there is no element of exploitation, such as financial gain, then addressing an issue in a way that may help but will not cause harm is certainly something I would consider.
I attended the SCLOSS conference last weekend (full reports soon) and was reminded of the great value of case studies and personal experience. Before we totally dismiss the anecdotal, it is worth remembering how useful it is to hear how colleagues have managed interesting patients. Peer review, despite initial reservation by many, has proved exceptionally popular, mainly for the very reason that it is useful to hear other people’s approaches and views.
In the new year, I want to introduce a ‘case study’ feature for this very reason and will be encouraging all of you to feel comfortable in submitting your examples from all areas of practice for debate and discussion. Look out for details in January.