Sunday, December 10, 2006

Over-reliance on RCTs leading to "evidence-based paralysis"?

Via DB's Medical Rants, retired doc has posted about the limitations of the randomized controlled trial in addressing some patient, diagnostic, and/or therapeutic situations - both posts note the use of the term "evidence based paralysis" in a letter to the editor of the Archives of Internal Medicine this past summer.

The letter to the editor (full-text access requires subscription) comments that there is a lack of RCT data to support tight glycemic control in type II diabetes, in response to this study by Ziemer et al which explored the use of computerized reminders and feedback to prompt closer clinician management of patient HbA1c levels. In their response to this letter, the authors of the original study note, "...we are concerned about "RCTomyopia" (belief that clinical action can be justified only by randomized, controlled trials) and "evidence-based paralysis" (unwillingness to take action without incontrovertible proof from controlled trials)."

The RCT design is expensive and challenging to execute appropriately; it is not feasible for some issues, or may not apply to the care of specific patients (e.g. due to exclusion of relevant patients in the original RCT). Future JMLA cases will discuss potential reasons for lack of RCT data to address a given clinical situation; retired doc's post is a great lead-in to this future discussion.

Related links:
The term "evidence-based paralysis" is also used here and here and a few other sites via this Google search.

Also via the Evidence-Based Nursing and Midwifery blog, an interview with Dr. Michael Ashby (published in the HLA NEWS, the National Newsletter of Health Libraries Australia), Director of the Centre for Palliative Care at Melbourne University in Australia, notes the potential for "therapeutic paralysis" with excessive focus on requiring RCTs to support clinical practice decisions.


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