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SUMMARY

Understanding the evidence base: the need to critically examine all the studies and evidence on drug related interventions as collected and analysed by the Cochrane Collaboration Marina Davoli Co-ordinating Editor Cochrane Drugs and Alcohol Review Group Lisbon, 6-8 May 2009. Why the evidence base

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SUMMARY

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  1. Understanding the evidence base: the need to critically examine all the studies and evidence on drug related interventions as collected and analysed by the Cochrane CollaborationMarina DavoliCo-ordinating Editor Cochrane Drugs and Alcohol Review GroupLisbon, 6-8 May 2009

  2. Why the evidence base Where is the evidence Future challenges and perspectives SUMMARY

  3. A reminder of the responsibilities of practitioners, policy makers and researchers to the publicGood intentions and plausible theoriesare no substitute for reliable evidence from empirical research about the effects of social and healthcare interventions Iain Chalmers, 8° CC 2000

  4. …could it be achieved earlier? Example I: SIDS

  5. Example 1: SIDS Systematic review of effectiveness: RR of death by sleep position Jilbert, IJE 2005

  6. Jilbert suggests that the delay is attributable to a greater “believe” in theoretical mechanisms (cardiac, cerebral, etc) of death than in the evidence of effectiveness From 1970 to 1992 10000 US and 50000 european children could have survived if guidelines would have issued earlier Example 1: SIDS Jilbert, IJE 2005

  7. Example 2Interventions intended toprevent delinquent adolescents from becoming career criminals

  8. Powys 5.1% Surrey 5.9% Suffolk 8.1% Norfolk 8.3% Gloucestershire 9.8% Nottinghamshire 21.1% South Yorkshire 21.9% Northumbria 25.3% Kent 26.1% Hertfordshire 31.6% The likelihood of a prison sentence for a17-20 year old convicted of criminal damage Home Office statistics for Crown Courts in 1988, Guardian 23 Jan 90

  9. Sentences for a 19-year old armed robber who stole £800,000 with four others in a bank raid Nigeria Death N Zealand 9 years H Kong Life India 7 years Texas 99 years Denmark 6 years Greece 20 years Canada 5 years England 14 years Norway 2 years Scotland 10 years Survey of the International Bar Association (1990): based on judges’ and legal experts’ responses to hypothetical cases International variation in sentencing policy

  10. RCTs of ‘Scared Straight’ programmesTrial Change in criminal behaviourMichigan 1967 26 % increase Greater Egypt 1979 5 % increaseYarborough 1979 1 % increaseOrchowsky 1981 2 % increaseVreeland 1981 11 % increaseFinckenauer 1982 30 % increaseLewis 1983 14 % increasePetrosino et al 2000

  11. ConclusionsResponsible professionals in the health and social services need more thangood intentions and plausible theoriesto guide their practice.Their prescriptions and proscriptions for others should be informed by reliable research evidence showing that they are more likely to do good than harm.

  12. The Cochrane Collaboration An international network of people who conduct, update and disseminate systematic reviews of the effect of health care interventions. There are 51 Review Groups in the Cochrane Collaboration

  13. Marina Davoli: Co-ordinating Editor Laura Amato: Managing Editor Simona Vecchi:Trial search Co. Zuzana Mitrova: Assistant Co. Robert Ali (Australia) Zhao Chengzheng (China) Fabrizio Faggiano (Italy) Michael Farrell (UK) David Foxcroft (UK) Walter Ling (USA) Cochrane Review Group on Drugs and Alcohol The editorial base The Editors

  14. RCTs on interventions for drug addiction (n=6530) Specialized Register Drugs and Alcohol Cochrane Group. CL 2.2009

  15. Cochrane Systematic reviews • Are the result of a complex process : • Formulate a proper question • Comprehensive study search • Objective selection and data extraction • Critical evaluation of primary studies • Synthesis • Update

  16. State of the art CLIB 3.2009 http://www.cdag.cochrane.org *629 studies included/1824 considered for inclusion

  17. Effectiveness of all interventions considered in CRs published in CLIB 3.2009

  18. ALCOHOL PSYCHOSTIMULANTS OTHER 16,6% 27% 60% 13% 83,3 N= 8 N= 25 N= 15 100% PREVENTION OPIATES POLY DRUGS 7% 10% 13% 20% 27% 43% 20% 27% 70% N= 48 N= 20 N= 15 46% 17% Beneficial or likely to be beneficial Unknown effectiveness Trade off between benefits and harms Unlikely to be beneficial Likely to be ineffective or harmful

  19. http://www.who.int/substance_abuse/publications/opioid_dependence_guidelines.pdfhttp://www.who.int/substance_abuse/publications/opioid_dependence_guidelines.pdf

  20. Cochrane reviews provide the “best available evidence” answering the questions they are planned to answer Cochrane reviews sometimes provide useful results to identify effective interventions They also identify a wide range of interventions unlikely to be beneficial and even likely to be ineffective or harmful Cochrane reviews also help in identifying areas where more systematic reviews are necessary and areas where more primary research is required CONCLUSIONS

  21. BUT….

  22. Ask the question: Help in prioritizing questions to be addressed by systematic reviews in order to be relevant for: Patients and their families Care givers Policy maker Less than 1/3 of published studies considered for inclusion Support in making the evidence available and accessible Use the evidence to inform guidelines The Cochrane Collaboration is a “virtual” organisation open to all possible contributions THE EMCDDA AND THE EU SCIENTIFIC COMMUNITY PLAY A KEY ROLE

  23. Country of origin of the studies included in the Specialized Register 0.3% 0.5% 4.1% 4.4% 21.7% 68.3% 0.7%

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