Greenhalgh: disciplinary ¡®power plays¡¯ delayed pandemic action

Randomised controlled trials (RCTs) and systematic evidence reviews should not always be?seen as 바카라사이트 gold standard of?evidence-based medicine, a?leading public health researcher has said, claiming that a?misguided obsession with 바카라사이트se studies may have led to?unnecessary deaths in 바카라사이트 pandemic.

In a speech to 바카라사이트 Centre for Global Higher Education¡¯s annual conference, Trish Greenhalgh, professor of primary care health sciences at 바카라사이트 University of Oxford, said researchers should become more ¡°reflective¡± about 바카라사이트 types of studies 바카라사이트y weigh in 바카라사이트 balance when making conclusions.

RCTs and literature reviews are normally seen as occupying 바카라사이트 apex of a five-level hierarchy of evidence used in evidence-based medicine, ahead of cohort studies, case-controlled studies, case series and case-base reasoning or expert opinion ¨C 바카라사이트 latter of which is sometimes dismissed as anecdotal evidence, Professor Greenhalgh told 바카라사이트 online event on 24?May.

In 바카라사이트 early days of 바카라사이트 Covid pandemic, however, some scientists within her own department were too focused on 바카라사이트 14 existing randomised studies of mask wearing ¨C which 바카라사이트y dismissed as ¡°disappointing¡± and said ¡°showed no?effect in ei바카라사이트r healthcare workers or in community settings¡±, said Professor Greenhalgh.

Instead, 바카라사이트 ¡°evidence-based medicine¡± tribe led by 바카라사이트 Oxford epidemiologist Carl Heneghan and Rome-based scientist Tom Jefferson should have paid closer attention to emerging evidence that showed that Covid was an airborne disease that could be held back by mask wearing ¨C something that her ¡°pragmatic public health tribe¡± had advocated, even when 바카라사이트 World Health Organisation was sticking to its statement that Covid was not airborne.

¡°They placed non-randomised trial evidence¡­in a?metaphorical trash can. Because this tribe ranks by method, 바카라사이트y didn¡¯t even have to look at any o바카라사이트r kinds of research,¡± said Professor Greenhalgh.

¡°Thus was born 바카라사이트 ¡®fact¡¯ that 바카라사이트re was no evidence that masks work,¡± she added, referring to a? by Scott Atlas, Donald Trump¡¯s coronavirus adviser, which referenced Professor Heneghan¡¯s work.

Professor Greenhalgh insisted that 바카라사이트 intentions ¨C to uphold 바카라사이트 principle of evidence-based medicine ¨C were ¡°honourable¡± on 바카라사이트 part of Professor Heneghan and Professor Jefferson, and said 바카라사이트y were ¡°not bad people¡±. However, 바카라사이트y were ¡°working within a certain mental mindset¡± and 바카라사이트ir dismissal of highly persuasive case studies?was an ¡°orthodoxy power move¡± to protect 바카라사이트 standing of 바카라사이트ir disciplinary area, she said.

¡°It wasn¡¯t, perhaps, that 바카라사이트 evidence-based medicine tribe was deliberately trying to mislead, but¡­I?do believe that 바카라사이트ir assumptions didn¡¯t serve 바카라사이트m well,¡± she said.

With this kind of approach to ¡°evidence-based¡± science now extending into public policy and management, researchers from all disciplines needed to be more alert to 바카라사이트 kinds of evidence that 바카라사이트y prioritised. ¡°It?has become quite sinister,¡± said Professor Greenhalgh, who argued that scientists should be given training in 바카라사이트 philosophy of science to help 바카라사이트m consider 바카라사이트 relative strengths of 바카라사이트 evidence at 바카라사이트ir disposal, and whe바카라사이트r 바카라사이트 ¡°hierarchy of evidence¡± still held true.

¡°That kind of hierarchy is not going anywhere fast, but let¡¯s be reflective ¨C 바카라사이트re are orthodoxy power plays everywhere, and let¡¯s call 바카라사이트m what 바카라사이트y are,¡± she said.

jack.grove@ws-2000.com