William F. Garrity

The Dartmouth Biomedical Libraries are very active in supporting evidence-based medicine and healthcare.  (For instance, see http://www.dartmouth.edu/~biomed/institute2008/.) 

In the June 16, 2008, Scientific American (online) Community, is a post by Merrill Goozner, "Evidence-based medicine in Russia: the challenge and the hope."

MOSCOW – On my last morning in Russia, I dined with Vasiliy Vlassov, professor of research methodology at the Moscow Medical Academy and head of a small but feisty group of Russian physicians called the Society of Specialists in Evidence-Based Medicine. “We’re trying to get the government to cancel ineffective care,” he said.

Give me an example, I said as I bit into an inch-thick lox sandwich. “The salt rooms,” he replied without hesitation. A quick check online later found that halotherapy, or speleotherapy as it is sometimes called because aerosolized salt dust is administered in cave-like rooms, has been widely practiced in Eastern Europe for over 200 years. There are dozens of spas, including some in government-run hospitals and health clinics, offering the salt cure for almost every lung disorder, ranging from chronic pulmonary obstructive disease to seasonal asthma.

However, the practice, which has almost no following in the U.S., has never been systematically studied. The National Library of Medicine’s PubMed database contains just 14 citations for halotherapy – all written by Russian physicians and none involving a test on more than 138 patients. Most were on just a few dozen. “It is from the middle ages. It is nonsense,” Vlassov said.

It’s been nearly four decades since the Scottish epidemiologist Archie Cochrane introduced the concept of evidence-based medicine in the west. It spawned a worldwide movement among physicians called the Cochrane Collaboration. Committees were established to evaluate all the clinical trials in a given area of medicine and issue objective clinical practice guidelines. Many reformers in the U.S. believe getting physicians to use evidence-based “best practices” generated by independent groups like the Cochrane Collaboration as key to holding down health care costs, since it could eliminate many useless medical practices.

But whereas American physicians often must be persuaded to ignore powerful financial incentives and pay close attention to the evidence, their Russian counterparts face an entirely different problem. They don’t have the intellectual tools necessary to evaluate the evidence. The Cochrane Collaboration’s local chapter, which Vlassov headed, fell apart a few years ago. 

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