[Which therapy comparisons are fair?].
Two approaches to treatment comparison are discussed: According to the principles of evidence-based medicine (EBM), methods of comparison are graded on a study-type scale, with randomised controlled trials and meta-analyses of randomised trials ranking at the highest levels. In contrast, cognition-based medicine (CBM) is based on the physician's recognition of causality of a treatment in the individual patient. A careful examination of potential sources of misinterpretation reveals that none of these approaches enforces fairness of comparisons: Randomised controlled trials often cannot be generalised, meta-analyses are based on retrospectively-selected studies and exposed to the ecological fallacy, and CBM approaches are not sufficiently controlled. Thus, fairness does not result from the choice of a perfect method or from the tailoring of the evaluation method to the therapy under examination. Rather, a complementary approach of different evaluation methods with all treatments to be compared should be used, with open discussion of strengths and weaknesses of the approaches applied in each particular case.
Wegscheider
Karl
K
Institut für Statistik und Okonometrie, Universität Hamburg, Hamburg. wegsch@econ.uni-hamburg.de
D015510:Clinical Medicine / Q000592:standards*; D003071:Cognition; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic