Evidence Live 2013: Librarians at the cutting edge of evidence based healthcare

1 05 2013


Evidence Live 2013 featured everything (and more) I had hoped to experience at a conference: debate, questioning, new ideas, and a very public argument between two of the keynotes speakers…

The conference was held at the Examination Schools at Oxford University, a prestigious venue that was fitting for the evidence based practice ‘heavyweights’ that were present.  The full programme and details about speakers are on the conference website and below I explore some of my personal highlights from the two day event.

It’s fair to say that Sir Muir Gray was one of the most highly anticipated speakers of the conference, and he did not disappoint. Sir Muir is the Chief knowledge Officer of the NHS, Director of The Oxford Centre for Healthcare Transformation and was knighted in 2005 for services to the NHS.  He took the audience back to the NHS of the 1950s, when the paradigm of that decade was that healthcare was free; a right rather than a luxury.  In the 1970s and 80s, that paradigm shifted to evidence based practice.  The 1990s brought a new healthcare paradigm of cost effectiveness, and the early 2000s became a decade of quality and safety in healthcare.  He asserted that the healthcare paradigm of the current decade is one of ‘personalisation and population’.  Rather than asking “Did x achieve the results that the evidence suggests?” we are now asking “Is the person’s problem better, no better, or worse?”.  Sir Muir highlighted that there’s still simple questions that the health care system can’t answer in relation to populations, such as “Is epilepsy care in Leeds better than in Sheffield?”.

He described the current healthcare system as one that consists of isolated pockets that don’t communicate.  He convincingly proposed an alternative ‘russian doll’ system of healthcare, which gives the patient appropriate support from self care to specialist care.  He ended his visionary talk with the stirring thought that “It is our responsibility to leave the health service in a better condition than we found it”.

After reading Bad Science by Ben Goldacre a couple of years ago I quickly became a fan, so I eagerly awaited his talk at Evidence Live.  Ben opened by stunning the audience with the extent of the impact of publication bias: 50% of all studies remain unpublished.  Ben is one of the leads for the All Trials campaign, which asserts that “if action is not taken urgently, information on what was done and what was found in trials could be lost forever, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated unnecessarily”.  The campaign urges people to sign a petition to ensure steps are taken to register all trials past and present, and report the full methods and results.  Since January 2013 over 40,000 people have signed the petition.  Ben spoke eloquently and captivatingly, and the room was so quiet during his talk that you could have heard a pin drop.  In speaking on this subject at an evidence based healthcare conference, he was preaching to the converted, but nonetheless it generated some interesting discussion.

Something that caused much more of a stir at the conference was an ongoing debate about the necessity of screening programmes for breast cancer.  On day one of the conference, Patrick Gotzsche (Director, the Nordic Cochrane Centre) presented convincing evidence from a Cochrane review that breast cancer screening in Denmark doesn’t save lives, in fact, it leads to ‘overdiagnosis’, and the radiotherapy administered could actually cause harm to otherwise healthy women.  He asserted that there are two big screening lies: 1. Screening saves lives, 2. Screening saves breasts – both, he says, are untrue; in fact, screening doesn’t work and it causes cancer.  He ended his rousing talk with the challenge: which country will have the political guts to stop screening?

As if this wasn’t controversial enough, the next day came a response from Jack Cuzick (Wolfson Institute of Preventive Medicine).  He criticised the systematic review process, particularly the Cochrane review methodology, citing “a gross misuse of statistics” in a prostate cancer screening Cochrane review.  The room rippled with excitement as we awaited questions from the floor, and there was outrage on the #evidencelive2013 hashtag on Twitter.  Open criticism of the Cochrane review process wasn’t something I expected to encounter at Evidence Live, but it just goes to show nothing should be taken as read, and for me it highlighted the need to critically appraise evidence from all sources and from all levels.

Aside from the riveting speakers, the thing that interested me most was the use of Twitter at the conference.  This was the first conference I’ve been to where the debate on Twitter was as active as the debate in real life.  The data shows that there were 3715 tweets during the two day event from 646 participants.  At one point the conference hashtag was trending.  I’ve created a Storify of some of my personal Twitter highlights from the conference.

I exploited this enthusiastic use of Twitter to promote my poster which was on display in the break-out area.  Utilising Twitter in this way helped me to engage with people at the event whom I didn’t have the chance to speak to face-to-face.  It also helped to connect with other librarians who were at the conference, and to arrange to meet them for a chat.  I was pleased by the number of librarians at the conference – there were more than I expected, and it is really encouraging that we are engaging with the cutting edge debate around evidence based healthcare.