Wednesday, November 15, 2006

A really early start – up at 4 a.m. for the flight to Copenhagen and the WHO’s European Advisory Committee on Health Research. We continue to struggle with the problem of how to contextualise evidence. We all know that you cannot simply take evidence from one setting and apply it uncritically in another. Yet we also know that it would be wrong to say that nothing can be applied in another setting.
Often the ability to contextualise evidence simply comes with experience. The more experience one has, the easier it is to discern patterns. Yet how do we help those who have less experience to know when evidence can be applied in different settings.
The problem is particularly great in the former Soviet Union. Although Russian science flourished in the early years after the October Revolution, Stalin’s great break soon brought progress to a halt. A new form of Soviet science, based on ideology, emerged. Soviet scientists became increasingly isolated from developments elsewhere. This meant that, although the Soviet health system achieved much by scaling up basic interventions until the 1960s, it faltered after that, as it was unable to develop a modern pharmaceutical and medical technology industry. This, in turn, meant that the concept of evidence-based health care never developed, something I addressed in my 2006 Cochrane lecture (Cochrane on communism: the influence of ideology on the search for evidence).
The Soviet Union is no longer with us, but its legacy remains. My collague Kirill Danischevski has shown how many aspects of obstetric care in Russia at entirely at odds with the evidence. Many health professionals still have very little access to international medical developments. The challenge is enormous….