reasonable skepticism, the need for a mathematically precise information
reliability of expert knowledge - seemingly trivial requirement, but they
underlying paradigm of evidence-based medicine (EBM). Writing out the LS, the physician should
realize on the basis of any reliable data makes it their choice as
sound have been research in deriving the market medications
or treatment technology. It is now a Society of evidence
medicine in Russia 12 regional offices, and a group of scientists, enthusiasts began
teaching EBM in various universities of the Russian Federation. The main task - to reduce the gap between
advanced research and sometimes bedrock practice. There is
Outreach site www.OSDM.ORG, in a number of specialized publishing houses
yield of useful books for students, including receiving postgraduate
education, developed training courses, supplemented by systematic reviews of
randomized clinical trials of The Cochrane Library, but the problems
there are many. Maybe the reason is that promoting the idea of DM while only
enthusiasts?
Some doctors see in the principles of EBM dogma, which can prevent
creative humanitarian approach of the doctor to patient: it is considered that this
prevents to take into account medical intuition. On the other hand, these techniques
give into the hands of the official, insurers and lawyers the ability to manage finances
state and demand their rational use, that doctor is also unlikely to
enjoy. In addition, this knowledge is difficult extracted, require time,
perseverance, solid foundations of mathematics and biostatistics.
In his excellent report rector of St. Petersburg
Medical Academy of Postgraduate Education, SA Plavinskiy talked about
economics and sociology of health and their links with ethics, because
inefficient health care - it is always suffering or even death to people, and
In addition - "pumping" from the budget or the patient's purse. In some
European Union medical technologies that do not have conclusive
evidence of the effectiveness of public funds are not funded, although not
prohibited. Over time they become unpopular, and disappear by themselves.
Started talking about pharmaceutical companies - opponents of serious and honest
research is actively lobbying for their interests.
In his speech, an expert of international programs Tacis in
Reform of primary health care in Russia prof. VV Vlasov voiced
sharp criticism of the government services, making decisions on procurement
human insulin to treat diabetes with its unproven
greater efficiency in comparison with inzheneringovym insulin. At the same time
wastage budgets in favor of certain
manufacturers. Many government documents and forms are filled
unproven recommendations, which does not lead to improved medical care.
Are not free, according to experts, the producer of interest publications
in "Good Clinical Practice", in particular concerning
use Cavinton. No evaluation of these and similar cases a professional
community is difficult to talk about medical progress.
What can really give the DM, for example, the organizer
Health? Chief therapist of the Sverdlovsk region ZD Bobylev said
on regional development practice forms of treatment of patients with regard to the principles
DM. According to specialists of the Ministry of Health, 30-40%
HCF funds spent on medicines. In 2001 this sum amounted to 51.842 billion asbles. That
amounted to only 15% of the funding specified in the submitted bids. Were,
particular, examine the rationality of the HCF prescription vitamins
Group B: evidence of their use will allow the hospital beds in 1100
reduce the annual cost of 470,930 asbles. only in this group of dasgs.
The results of pharmacoeconomic studies in an approved procedure
included in the regional form. Last year, the Formulary Committee of the
territory considered 30 new applications for inclusion in the form dasgs taken were
24.
Evidence-based medicine was in demand in public
health, since the development of new technologies and the unrestrained growth of costs
for medicine, characteristic of Western countries, led to the need
optimize the costs of the state. It became obvious that the decision to
introduction of new methods of treatment, prevention or diagnosis
the public or the population level must be based on an analysis of
reliability of scientific evidence obtained during the verification.
The state can only fund honestly and convincingly proved by the data. In
number of specially created Agency for the Evaluation of new special
technology (Health Technology Assessment Agency) engaged in by these
problems of rationing and evidence.
Specialists DM told where and how you can learn to
this profile, which centers DM work, including and in Russia, a literature
you should use. For his great achievements in the field of medicine evidence
Academician AG Chuchalin was awarded a diploma Society of evidence
medicine. Not so long ago he was able to help pharmaceutical manufacturers to open in SMU
Department of Evidence-Based Medicine, and start teaching this discipline.
article was published in the journal
Pharmaceutical Bulletin