english.prescrire.org > Positions > Basic principles > A firm foothold

Theme: Basic principles

What are the tenets that underpin our approach? A scientific spirit, respect for the evidence, tempered by scepticism. Humility, empathy and unwavering devotion to the patient’s interests. Most crucial perhaps is independence.

A firm foothold

Day-to-day medical practice is full of pitfalls. Reliance on solid evidence is a good way to avoid many of them.

Providing care, prevention and advice means constantly dealing with uncertainties and probabilities, possibilities and impossibilities. The solid information needed is often scattered and difficult to access, lost in a maze of approximations, hypotheses and rumours.

It is therefore impossible for anyone to constantly verify, in every field, data that can be relied upon to make good decisions. We must rely on others, and delegate the reviewing of information to organised teams, in exchange for certain guarantees: especially, guarantees of independence, and the use of rigorous methodology in their work; guarantees of thoroughness and of an up-to-date literature search. Can the media or the institution that publishes a review guarantee that the authors' methodology and work are free from conflicts of interest? Do the authors clearly state the "questions" that they set out to answer? Was their search for documentation thorough, specific, up-to-date, and did they specify the date on which the search was conducted? Was this information clear, coherent, and well-referenced? Does it clearly take into account the boundaries between what is known and what the existing gaps in knowledge are, between established fact and hypothesis, data and commentary on the data?

Does the review point out precise, coherent facts backed up by clinical evidence, which can be used as guidelines for practice? For this is the crux of the matter, and the goal: to narrow down the precise area of established knowledge, in order to be able to best apply it in practice. But also to be aware of its limits; in the many situations that are not covered by clinical trial evidence, doctors have to rely on their judgement.

Prescrire's editorial staff seeks to deliver maximum guarantees to healthcare practitioners and to patients: independence, rigour, accuracy. They are constantly seeking reliable and useful information. They are constantly reinforcing their efforts to fulfil their responsibility: to build a reference source of information, and to enhance subscribers' personal continuing education. But the last step is always up to the individual: to integrate this information into his or her decisions, methods, and clinical practice; while taking into account, case by case, the other intervening factors. A firm foothold, from which to face the difficulties of day to day medical practice.

©Prescrire 2008

Source: "Un pied sur du solide" Rev Prescrire 2008; 28 (298): 586.
Reprinted from Rev Prescrire 2003; 23 (238): 241.