Evidence-based practice?

Abstract

In 1948, the world of health and medical research changed forever with the publication of the Medical Research Council’s randomised controlled trial (RCT) on the use of streptomycin in the treatment of tuberculosis (TB).1,2 In that year, there were 341 papers on Streptomycin and TB published in the medical literature, but only one RCT, and this was the paper that defined a generation of TB treatment. The process of undertaking RCTs was quickly developed to include health promotion. In 1972, Prof Archie Cochrane published his definitive monograph on evaluation that eventually led to the establishment of the Cochrane Collaboration and the subsequent elevation of systematic reviews to their present position as the gold standard for health prevention, management and knowledge.3Cochrane’s legacy is best summarised in his quotation: “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, updated periodically, of all relevant randomised controlled trials.”4 Since the introduction of the RCT, there have been further developments in meta-analyses of RCTs and Cochrane reviews, and pooled data analyses. Pooled data analyses, such as the Oxford ovarian cancer collaboration, are more difficult to undertake as they require considerable effort to acquire data from all previous studies in a standardised format, but represent the highest level of science and knowledge.5 The Cochrane Collaboration has expanded rapidly and as we write this editorial there are now in excess of 5,000 reviews in their database. A total of 220 of the reviews include the key words ‘health promotion’ or ‘health education’, signalling that the RCT and systematic reviews have become powerful tools in health promotion. However, with the advent of such a powerful research tool comes responsibility. It is now the responsibility of health promotion researchers to register all RCTs with an appropriate registration authority. This is to ensure quality in studies, adherence to protocol and the availability of information for future replication. To support and maintain health promotion rigour, the Editors of this journal will encourage authors to register RCTs before commencement with an appropriate body, such as the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au)