MTV, sundhedstjenesteforskning og klinisk praksis

should be to ensure that it will address an important unanswered
question: those who ignore history risk doing uninformative and
unnecessary studies and repeating the mistakes made by their predecessors.
Quite apart from the issues raised by inefficient use of limited resources
for research, there are worrying ethical concerns raised by
failure to prepare systematic reviews of past studies before doing
further research, in particular, when this results in failure to recognise
that a therapeutic question has already been convincingly addressed.
Savulescu and his colleagues (4), for example, drew attention
to the unjustified continued use of placebos in trials of antibiotic
prophylaxis for colorectal surgery when there was evidence
from earlier trials showed that antibiotics reduce mortality.
How investigator and journal biases can pervert the research agenda
Another reason for insisting on systematic reviews of existing evidence
before doing further research is that, left to themselves, researchers
often design trials to address questions that are of no interest
to patients (5, 6). This mismatch often seems to reflect perverse
incentives – academic and commercial – to pursue particular
research projects. Investigators working in intensive care units, for
example, are currently being paid substantial amounts of money to
recruit participants in trials investigating the effects of new neuroprotective
agents on surrogate measures of outcome. These financial
incentives mean that clinical researchers are not addressing
important unanswered questions about many existing elements
of intensive care. For example, every year, tens of thousands of patients
with severe head injury are hyperventilated and given mannitol,
barbiturates and/or corticosteroids, yet systematic reviews of
the available controlled trials have shown that there is uncertainty
about whether any of these widely used interventions increases or
decreases death or disability (7-10).
The widespread use of human albumin solution in intensive care
presents an even more worrying situation. Eight tonnes of albumin
are given to British patients at a cost of over £12 million pounds
annually, yet the mortality data in the available controlled trials
suggests that this is likely to be contributing to the premature
deaths of many hundreds of critically ill patients every year (11).
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