Send letter to journal:
Re: Are We Ready for Evidence Based Medicine?

Dear Editor

The letter Tony Lopez from was very timely. Archimedes is sometimes over the top in applying evidenced based medicine in an A&E set up trying to find instant solutions for age old controversies like steroids use in meningitis. These kind of rapid evidence search may result in inferior quality or even wrong answers being generated. In fact some of the CAT (Critically Appraised Topic) posted in the best bet site have different conclusions from the Michigan CATS on same topics.

As a new enthusiastic registrar with a special interest in evidenced-based medicine, I started CAT (critically appraised topic) clubs (scrapping the old fashioned journal clubs) in our department. This includes a one-hour discussion evaluating all the evidence on a clinical query, trying to find out an evidenced-based answer. Unfortunately my experience has been very disappointing.

The first CAT club topic was on caffeine Vs theophylline in apnea of prematurity. Our unit has been using Theophylline probably since 2000BC.

My medline search included several good randomized control trials (RCT) and a Cochrane review on the topic. Conclusion was that caffeine was equally effective as theophylline, but caused much lesser side effects.

There was a big silence when I presented the data and conclusions. Few weeks later I was told by the consultant that they were not keen on changing the policy on apnea of prematurity, as theophylline was being used in the unit for centuries. However, they were willing to provide coffee instead of tea (presumably there is more caffeine in coffee) in the doctor mess for doctors who become apneac during on calls.

The second topic was on use of sucrose as an analgesic for venepucture in neonates. Presently we use no analgesia in neonates and pretend these procedures were painless. Several excellent RCT and two meta -analysis showed sucrose was a safe and effective analgesic for painful procedures. This time there was a roar of laughter from the consultants following the presentation. One of them came upto me and offered a spoonful of sugar. Immediately after consuming it, I received a punch on my nose.

Consultant: I am sorry, Did that hurt? Me: Of course it did Consultant: There you go. I told you sucrose is useless

I decided to kill my CAT after this episode. Few weeks later, I was summoned by one of the consultants.

Consultant: Do you mind giving me a copy of the CAT files, please...just for my personnel records.. Me: Oh' sure...

Few weeks later, I read a headline in the local newspaper.. "CHI impressed by Paediatric CAT" '...hospital have set an excellent precedence in practicing evidenced based medicine by introducing critically appraised topic discussions to improve quality of clinical care....'

And there after I decided to use more common sense (or sense common to all consultants rather)in paediatric practice.