Evidence Based Health Care is needed more than ever

The following was published as ‘Cochrane Gem’ in the National Electronic Library for Health in the UK in early January 2005, after the Indian Ocean tsunami of 26 December 2004 (called “Boxing Day” in the UK). It laid some of the foundations for Evidence Aid and we are re-publishing it, unchanged, now because of its resonance with the current, global, emergency

[[Gem for week commencing 4 January 2005]]

This isn’t a usual Cochrane gem, but this isn’t a usual time for health care in the world. Boxing Day changed things. One large part of the world is weeping, and the world as whole is trying to help. The financial generosity of people in countries such as this is heart warming, just as the tragedy for the people in the countries affected is heart breaking. Both bring a lump to the throat and a tear to the eye. Both ignite a human need to do something to help.

How can people involved in the preparation and dissemination of high quality evidence on health care help? For some, the answer may lie in the very way that we found our about the tsunami and its tragic aftermath: information and its accessibility. On the morning of 26 December, I was on the internet trying to find a bargain to escape the slumberland that rests between Christmas and the New Year. AOL’s home page mentioned an earthquake in the Indian Ocean, among the most powerful in living memory, and a tidal surge that had caused costal floods in several countries. I cannot remember if a death toll was mentioned. Going to the TV and making use of the Freeview box that had been bought as a present by the family to the family, I had a choice of 24-hours news channels. The story and the horror unfolded there over the next hours and days. From the first reports of a few thousand dead and tens of thousands homeless across the entire region to, within a day, a few thousand dead and tens of thousands missing in one part of Indonesia alone.

What can we do? Aid needs evidence on what works and what doesn’t work. It is no good and, worse, might be harmful, to deliver health care that is ineffective. The Cochrane Library already contains several reviews of relevance. There are Cochrane reviews on overcoming the effects of dehydration and the treatment of injuries, both physical and psychological. Efforts are now underway to identify those topics that would benefit most from new or updated reviews.

Those of us who work in the production of evidence can, therefore, deliver our own form of aid: information. The rapid communication of information is how most of us heard about the disaster. The provision of reliable information on the effects of health care is the way that many of us can contribute to alleviating its effects. We need to recognise the privileged position that we are in: we can help by doing what we do best.

Of course, there is the challenge that the 150,000 deaths last week is small in comparison to the millions of deaths from preventable and treatable diseases around the globe, and the world has never mobilised before to tackle those problems. That may be a valid criticism, but it is not a valid reason to say “well, let’s do nothing now”.

This crisis is immediate, it is happening now, it is happening in front of the eyes of millions of people in the affected regions and also in front of us in our newspapers, televisions, radios and internet. Whether or not being confronted so directly by the tragedy should make a difference, doesn’t really matter. It does make a difference. And, if one of the basics of being human is feeling compassion in the face of the suffering of others, now is a time to be human, to feel compassion and to respond in whatever way seems best.

4 January 2005