143
Editorial
Álvaro Nagib Atallah*
Sao Paulo Med J/Rev Paul Med 1999; 117(4):143-4.
The impo rtance o f medical practice based o n the best existing level o f scientific evidence is to day no lo ng er under discussio n in develo ped co untries and within the mo st up-to -date medical scho o ls.
Evid e nc e -b a se d me d ic ine is a lre a d y inc lud e d a mo ng the re q uire d c o nc e p ts a nd premises o f entities suc h a s the British Ro ya l Co lleg e, American Co lleg e o f Physicians (vide: ACP Club Jo urnal), US Ag ency fo r Research and Health Po licy, American Medical Asso ciatio n, W o rld He a lth O rg a niz a tio n, a s w e ll a s g o vernments and research ag encies in the United Sta tes, Ca na da , Eng la nd, Austra lia , N o rwa y and Sweden.
In Bra z il, in a dditio n to the Asso c ia ç ã o Paulista de Medicina, the Co nselho Federal de Medicina has established parameters fo r medicine based o n scientific evidence to maintain co herence with its co mmitment to ethical practice. The new President o f the Asso ciação Médica Brasileira, Pro f. Dr. Eleuses Paiva, has already declared that his pro po se d wo rk pro g ra m will inc lude the creatio n o f a co nsensus aro und the framewo rk o f evidence-based medicine. Such an idea o f seeking efficiency in co nso nance with ethics, based o n valid prio r scientific evaluatio n o f every diagno stic, therapeutic o r pro phylactic pro cedure, is already
co nso lidated in o ur enviro nment. The present co nso lidatio n may be taken as greatly ho no ring the pro fe ssio na l a nd a c a de mic ra nks within Bra z ilia n Me dic ine , whic h ha ve b e e n distin-guishing themselves internatio nally in the pro cess o f c o ntinuing e d uc a tio n b a se d o n sc ie ntific a c c e p ta nc e o f mo d e rn me tho d s in c linic a l epidemio lo g y.
W ith the reco g nitio n o f the impo rtance o f this kno wledg e having been co nso lidated, ho w c a n w e ma inta in the up -to -d a te p ra c tic e o f evidence-based medicine?
144
Sao Paulo Med J/Rev Paul Med 1999; 117(4):143-4.
pro fessio nals and that has direct benefits fo r the health o f the po pulatio n.
Ho w do es the pro g ram wo rk? Reco g nized autho rities o n subjects o f interest to the medical pro fessio n are invited to present their kno wledg e o n the pro g ram, o rientated to avo id perso nal o pinio ns and co nfine their affirmatio ns to the best scientific evidence available. Q uestio ns related to characteristics and sequence o f teaching are discussed with the Directo r o f the pro g ram, who is a g eneral clinician trained in clinical research. The invite d spe c ia list is the n inte rvie we d b y do cto rs with kno wledg e o f the basic co ncepts o f evidence-based medicine. The main references a re d isp la ye d a t the fo o t o f the vid e o . The Bra z ilia n C o c hra ne C e nte r pla c e s its re vie w services at the dispo sitio n o f the invitees. In this ma nne r, a ro und 7 5 0 the me s, c o ve ring the interests o f the majo rity o f medical pro fessio nals, have been reco rded o n video and successfully transmitted thro ug ho ut the co untry during these fo ur years. Aro und 2 0 0 chair-ho lding pro fesso rs fro m the b est sc ho o ls a nd hundreds o f o ther re se a rc he rs o f no le sse r imp o rta nc e ha ve pro vided relevant services to the pro fessio n and Brazilian so ciety using their kno wledg e.
Fo ur o pinio n po lls, the latest o f which was the mo st extensive, with 2 5 0 0 questio nnaires answered, have revealed that 9 7 % o f do cto rs co nsider the pro g ram to be impo rtant fo r keeping the ir o w n kno w le d g e up -to -d a te . N ine ty-five p e rc e nt o f the re sp o nse s ind ic a te d tha t the pro g ra m wa s g o o d o r ve ry g o o d (a n inde x repeated in all fo ur po lls). Aro und 1 0 % watch
the pro g ram every week and aro und 6 5 % watch it at least o nce a mo nth. Eig hty percent o f do cto rs are able to receive the channel that bro adcasts the pro g ram.
Several co untries have manifested interest in the pro g ram. In March 1 9 9 9 we were invited by the Directo rs o f the Co chrane Center o f the University o f Freiburg in G ermany to present the co ncepts o f the pro g ram, which they intend to repro duce in the same fo rmat in that co untry.
In this way, a simple, cheap and practical manner has been devised fo r putting the best in medical info rmatio n at the dispo sitio n o f health pro fessio na ls via the Asso c ia ç ã o Pa ulista de Medicina, with benefits fo r health pro fessio nals, fo r patients and fo r so ciety.
The ne xt ste ps in the re fine me nt o f the pro g ram sho uld be the publicizing o f the results fro m the c o nse nsus b e ing d e ve lo p e d a s a c o lla b o ra tio n b e tw e e n the Unive rsitie s a nd Medical Asso ciatio ns. Pro g rams aimed to lay p e o p le sho uld b e d e ve lo p e d tha t ta ke the kno wledg e o f what has been scientifically pro ven to wo rk to the patients and the po pulatio n in g eneral, who sho uld be the fo cus o f refinements in the activities o f health pro fessio nals. Po litical suppo rt will thereby accrue, and, mo re than ever, such suppo rt is seen as fundamental in allo wing sc e na rio s o f he a lthc a re to b e mo d ifie d via science, ethics and efficiency.
