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Centre for Evidence-Based Medicine

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Centre for Evidence-Based Medicine (University of Oxford)
Centre for Evidence-Based Medicine, Universoty of Oxford
Parent institution
University of Oxford
DirectorProf. Carl Heneghan
Academic staff
Students5 Full-time DPhils, 28 part-time DPhils and 75 MSc students
United Kingdom

The Centre for Evidence-Based Medicine (CEBM) based in the Nuffield Department of Primary Care Health Sciences in the University of Oxford is an academic-led centre dedicated to the practice, teaching and dissemination of high quality evidence-based medicine to improve healthcare in everyday clinical practice. CEBM was founded by David Sackett in 1995. It was subsequently directed by Brian Haynes and Paul Glasziou. Since 2010 it has been led by Professor Carl Heneghan, a Clinical Epidemiologist and General Practitioner.[1]

There are currently over 25 active staff and honorary members of the CEBM. Many of the active staff include other clinicians, statisticians, epidemiologists, information specialists, quantitative and qualitative researchers. Philosopher of Evidence-Based Medicine Jeremy Howick is a former fellow of the CEBM.

Teaching and degrees[edit source | edit]

CEBM is the academic lead for Oxford University's Graduate School in Evidence-Based Healthcare, together with the Department of Continuing Education at the University of Oxford. The Graduate School includes a MSc in Evidence-Based Health Care[2] and a DPhil in Evidence-Based Health Care.[3] along with a range of short courses, including a course on the History and Philosophy of Evidence-Based Healthcare.

EBM Live conference[edit source | edit]

Every year, CEBM organises EBM Live, (previously Evidence Live)[4] a multi-day conference focussing on developments in the area of evidence-based medicine. The conference is organised in collaboration with the British Medical Journal. Themes for the conference include Improving the Quality of Research; disentangling the Problems of Too Much and Too Little Medicine; transforming the Communication of Evidence for Better Health; training the Next Generation of Leaders and translating Evidence into Better-Quality Health Services.

Notable projects[edit source | edit]

Levels of Evidence[edit source | edit]

CEBM has developed a widely adopted[5] systematic hierarchy of the quality of medical research evidence, named the levels of evidence. Systematic reviews of randomised clinical trials (encompassing homogeneity) are seen as the highest possible level of evidence, as full assessment and aggregated synthesis of underlying evidence is possible.

Tamiflu[edit source | edit]

In collaboration with the British Medical Journal, Carl Heneghan and team found no evidence that Tamiflu helped to reduce complications of influenza.[6][7] This has become a controversial topic, as the United Kingdom government spend £473 million on the purchase of Tamiflu, despite the systematic review[8] claiming to find no evidence for the effectiveness of it.[9]

Sports Products[edit source | edit]

A systematic review conducted in 2012 discovered a very little effect of carbohydrate drinks on sport performance of the general population.[10][11] This work formed part of a joint investigation with BBC Panorama and the British Medical Journal.[12] A linked article published in the BMJ reported a "Striking lack of evidence" to back up claims for popular sports brands.[13] A further analysis of a broad range of sports products showed that the evidence for many sports products is poor quality and insufficient to inform the public about the benefits and harms of sports products.[13]

Self Care[edit source | edit]

Systematic review and individual patient data meta analysis research[14] in the centre has shown that even with little training people on oral anticoagulation (Warfarin) can successfully self-monitor, and even self-manage their disease in the community.[15] Patients capable of self-monitoring and self-adjusting therapy have fewer thromboembolic events and lower mortality than those who self-monitor alone.[16] In 2014, Carl Heneghan along with Alison Ward became directors of a World Health Organization Collaborating Centre for Self-Care in Non-communicable disease.[17]

All Trials[edit source | edit]

The centre is one of the co-founders of the AllTrials campaign, which has been influential in ensuring that the results of all clinical trials are registered and reported in full.

Diagnostic Technologies and Reasoning[edit source | edit]

The centre has a strong diagnostic theme which includes assessing novel Diagnostic Technologies relevant to improving the diagnosis of disease in primary care and also to improving diagnostic reasoning. In 2015, the centre produced a report for the Department of Health (United Kingdom) on Antimicrobial resistance diagnostics which highlighted the considerable number of new diagnostic technologies in development to underpin rational prescribing of antibiotics.[18]

COMPare Project[edit source | edit]

In 2015 the COMPare project was launched: Outcome switching in clinical trials is a serious problem. The project systematically checks every trial published in the top five medical journals, to see if they have misreported their findings, comparing each clinical trial report against its registry entry. The project has found that some trials report their outcomes perfectly, but for many others outcomes specified in the registry entry were never reported. The updates to the trials are updated live on the COMPare website. The project highlights how researchers are duped by the common practice in clinical trial reporting of "outcome switching".[19]

Adverse Events[edit source | edit]

In March 2016, research in the centre systematically identified 353 medicinal products withdrawn worldwide because of adverse drug reactions, assessed the level of evidence used for making the withdrawal decisions, and found that only 40 drugs were withdrawn worldwide.[20] Withdrawal was significantly less likely in Africa than in other continents (Europe, the Americas, Asia, and Australasia and Oceania).[21] Furthermore, in 47% of the 95 drugs for which death was documented as a reason for withdrawal more than 2 years elapsed between the first report of a death and drug withdrawal.[22]

Research fellows[edit source | edit]

2015 Research fellows listed on the CEBM website include:[23]

Notable honorary fellows[edit source | edit]

Notable fellows include:[24]

References[edit source | edit]

  1. http://www.phc.ox.ac.uk/research/oxford-centre-for-evidence-based-medicine[full citation needed]
  2. "MSc in Evidence-Based Health Care". Retrieved 23 July 2015.
  3. "DPhil in Evidence-Based Health Care". Retrieved 23 July 2015.
  4. "Evidence Live Global Forum". Retrieved 24 July 2015.
  5. "Levels of Evidence / Google Scholar". Retrieved 24 July 2015.
  6. Butler, Declan (2014). "Tamiflu report comes under fire". Nature. 508 (7497): 439–40. Bibcode:2014Natur.508..439B. doi:10.1038/508439a. PMID 24759392.
  7. Heneghan CJ, Onakpoya I, Thompson M, Spencer EA, Jones M, Jefferson T (2014). "Zanamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments". BMJ. 348: g2547. doi:10.1136/bmj.g2547. PMC 3981976. PMID 24811412.
  8. Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Onakpoya I, Mahtani KR, Nunan D, Howick J, Heneghan CJ (2014). "Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children". The Cochrane Database of Systematic Reviews. 4 (4): CD008965. doi:10.1002/14651858.CD008965.pub4. PMC 6464969. PMID 24718923.
  9. "Tamiflu: Millions wasted on flu drug, claims major report". BBC. 10 April 2014. Retrieved 23 July 2015.
  10. "'Lack of evidence' that popular sports products work". BBC. 19 July 2012. Retrieved 23 July 2015.
  11. Heneghan C, Perera R, Nunan D, Mahtani K, Gill P (2012). "Forty years of sports performance research and little insight gained". BMJ. 345: e4797. doi:10.1136/bmj.e4797. PMID 22810388.
  12. https://www.bbc.co.uk/news/health-18863293[full citation needed]
  13. 13.0 13.1 Heneghan C, Howick J, O'Neill B, Gill PJ, Lasserson DS, Cohen D, Davis R, Ward A, Smith A, Jones G, Thompson M (2012). "The evidence underpinning sports performance products: a systematic assessment". BMJ Open. 2 (4): e001702. doi:10.1136/bmjopen-2012-001702. PMC 3401829. PMID 22815461. Lay summaryBMJ (18 July 2012). Cite uses deprecated parameter |laysource= (help)
  14. Heneghan C, Ward A, Perera R, Bankhead C, Fuller A, Stevens R, Bradford K, Tyndel S, Alonso-Coello P, Ansell J, Beyth R, Bernardo A, Christensen TD, Cromheecke ME, Edson RG, Fitzmaurice D, Gadisseur AP, Garcia-Alamino JM, Gardiner C, Hasenkam JM, Jacobson A, Kaatz S, Kamali F, Khan TI, Knight E, Körtke H, Levi M, Matchar D, Menéndez-Jándula B, Rakovac I, Schaefer C, Siebenhofer A, Souto JC, Sunderji R, Gin K, Shalansky K, Völler H, Wagner O, Zittermann A (2012). "Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data" (PDF). The Lancet. 379 (9813): 322–34. doi:10.1016/S0140-6736(11)61294-4. PMID 22137798.
  15. Ward A, Tompson A, Fitzmaurice D, Sutton S, Perera R, Heneghan C (2015). "Cohort study of Anticoagulation Self-Monitoring (CASM): a prospective study of its effectiveness in the community". The British Journal of General Practice. 65 (636): e428–37. doi:10.3399/bjgp15X685633. PMC 4484943. PMID 26077267.
  16. Heneghan, Carl J.; Garcia-Alamino, Josep M.; Spencer, Elizabeth A.; Ward, Alison M.; Perera, Rafael; Bankhead, Clare; Alonso-Coello, Pablo; Fitzmaurice, David; Mahtani, Kamal R. (5 July 2016). "Self-monitoring and self-management of oral anticoagulation". The Cochrane Database of Systematic Reviews. 7: CD003839. doi:10.1002/14651858.CD003839.pub3. ISSN 1469-493X. PMID 27378324.
  17. "WHOCC – WHO Collaborating Centres: WHO Collaborating Centre for Self-Care". WHO. 28 March 2014. Retrieved 13 August 2017.
  18. Pluddemann, Annette; Onakpoya, Igho; Harrison, Sian; Shinkins, Bethany; Shinkins, Bethany; Tompson, Alice; Davis, Ruth; Price, Christopher P.; Heneghan, Carl (June 2015). "Position Paper on Anti-Microbial Resistance Diagnostics". Centre for Evidence-Based Medicine.
  19. https://www.vox.com/2015/12/29/10654056/ben-goldacre-compare-trials
  20. Worldwide withdrawal of medicinal products because of adverse drug reactions: a systematic review and analysis.Onakpoya IJ, Heneghan CJ, Aronson JK. Crit Rev Toxicol. 2016 Mar 3:1–13
  21. Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature. Onakpoya IJ, Heneghan CJ, Aronson JK. BMC Med. 2016 Feb 4;14:10. doi: 10.1186/s12916-016-0553-2.
  22. Delays in the post-marketing withdrawal of drugs to which deaths have been attributed: a systematic investigation and analysis. Onakpoya IJ, Heneghan CJ, Aronson JK. BMC Med. 2015 Feb 5;13:26. doi: 10.1186/s12916-014-0262-7.
  23. "CEBM about". Retrieved 23 July 2015.
  24. http://www.cebm.net/about/

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