In this gloomy northern hemispheric spring, it seems there is something interesting and encouraging going on in public health.
Finally, perhaps the status quo in what is acceptable to inform clinical medicine is now changing, that it is understood that the public has the right to expect better evidence than what is now available and a growing group of health professionals, who span the spectrum from front-line GPs (including Margaret McCartney, via whom the image at the beginning of this blog comes) to systematic reviewers are rising to this challenge. In this they are supported by editors and, perhaps even most encouragingly of all, increasingly politicians and policy makers.
A couple of recent events give a real flavour of these changes. EvidenceLive, at the end of March, a conference run by the BMJ and the Centre for Evidence Based Medicine, Oxford (CEBM) was one of the most invigorating conferences I have been to for quite some time. Not only was there a real sense of a collective vision, evidenced by tremendous engagement from among the participants (including virtually on twitter #evidencelive) – so it was almost irrelevant who was a speaker and who was the audience – but also a sense that many strands were coming together and that the argument for the need for evidence informing healthcare was over (something that might seem blindingly obvious to an outsider), it was more about how to make it happen.
Of course in one important area the argument is not over – that of access to results and data from clinical trials – but even there the tide is, perhaps, turning. At the end of last year EMA announced its intention to make data from trials of the drugs it has approved available; the first part of this year is being spent in hammering out the details (two PLOS editors are on working groups for this). This process is not unquestioned, however, and it is notable that two companies are mounting legal challenges.
Transparency is not just an issue for commercial trials. An event last week at the European Parliament, called by Glenys Wilmott, a British MEP, discussed the issues of transparency in non-commercial trials, where the issues are perhaps more complex and the implementation possibly more thorny and which will form part of an act wending its way through the European Parliament. Interested organsations scenting the possibility of change as perhaps never before are redoubling efforts to inform MEPs directly.
But the forces for openness to evidence, all of it, are also now working via more open routes-that of public engagement. A movement that got new momentum with the publication last year of a popular book, Bad Pharma, by Ben Goldacre, excoriating the failures in this area – specifically the failure by the medical establishment, with its behind-the-scenes negotiations, to solve the issues they have known about for many years – has now become a high profile public petition. This is coordinated by Sense About Science, and calls for alltrials to be registered and all results reported; it is supported by many organisations (including PLOS) and is gathering signatures and support daily.
What next? It’s critically important that the momentum is not lost in interminable wrangling and much here will depend what decisions for example the EMA takes in the implementation of its policy and whether the alltrials petition can get the numbers it needs to be able to become an unstoppable force. But the signs are looking good; – so perhaps we could gloss over this bleak spring, and start a movement for an Evidence Summer?