The road to hell

Too often, evidence from clinical trials is being shamelessly extrapolated across time, population subgroup, and condition
The quality improvement movement within medicine is awash with worthy good intentions. The trouble is that those in the driving seat are often in a hurry and have an unfortunate tendency to cut important corners. If, as a result, the principles and methods of science are ignored, the good intentions become self defeating, unrealisable, and dangerous. This is sadly what seems to be happening. Good intentions are being enacted through a series of interventions that begin to represent something of a nadir in the ways in which research is translated into practice.
We are witnessing a degradation of knowledge, which results from its bureaucratic application to whole populations. Too often, evidence from clinical trials is being shamelessly extrapolated across time, across population subgroup, and across condition. Again and again, efforts are concentrated on crude process measures, while clinical outcomes that are genuinely significant for patients because they reduce or delay suffering or prolong life are ignored. Thirdly, the present state of clinical evidence systematically neglects the reporting of harms (www.aemg.cochrane.org/).

Iona Heath, general practitioner, London
aque22@dsl.pipex.com
BMJ 2007;335:1185 (8 December), doi:10.1136/bmj.39414.473600.59