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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Wednesday, June 20, 2007

Journal voters stray from the evidence

The results are in from the New England Journal of Medicine's first online poll of clinical decisions, and the winner was not a slam-dunk.

"What we learned from this is that evidence-based medicine is easy to talk about but hard to implement," editor-in-chief Dr. Jeffrey M. Drazen said in an interview.

Last month the journal asked readers to vote on how to handle the fictitious case of a woman who wanted to cut down on her medications for mild, persistent asthma. The vignette was created to accompany two articles on asthma treatment.

"People read those two papers and the vignette and came to very different conclusions," Drazen said.

Readers were given three choices to vote on. When the 6,085 votes from 113 countries were counted, two of the three choices were almost a tie, with only eight votes separating them. But the winner, with 37.5 percent of the votes, was not the choice consistent with what the two studies concluded, Drazen said.

"It appears that although we as physicians use new data, we do not slavishly follow them," Dr. Laura Fredenburgh of Brigham and Women's Hospital writes in tomorrow's journal.

That fits with the more than 340 comments the journal received, Drazen and Fredenburgh said. The doctors said they picked out different parts of the fictitious patient's story to guide their decisions.

Drazen said he was encouraged by the number of votes and the thoughtful nature of the comments.

"I was amazed," he said. "We'll probably do it again in the fall."

Posted by Elizabeth Cooney at 05:00 PM
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