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Comparative Effectiveness ResearchEvidence, Medicine, and Policy$
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Carol M. Ashton and Nelda P. Wray

Print publication date: 2013

Print ISBN-13: 9780199968565

Published to Oxford Scholarship Online: September 2013

DOI: 10.1093/acprof:oso/9780199968565.001.0001

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The Generation of Evidence in Medicine

The Generation of Evidence in Medicine

Evaluating the Benefits and Harms of Treatment

(p.3) 1 The Generation of Evidence in Medicine
Comparative Effectiveness Research

Carol M. Ashton

Nelda P. Wray

Oxford University Press

Federal mandates for comparative effectiveness research enacted during the 2000’s are intended to increase the kind of high-quality evidence that doctors and patients need for optimal clinical decision-making. Within the hierarchy of research designs, experimental designs—clinical trials— outweigh non-experimental designs in the ability to provide least-biased estimates that an intervention is likely to provide clinical benefit. Because of steady advances in the methods of clinical trials, we know how to generate high-quality evidence. Yet contemporary medical practice rests on a foundation of shaky scientific evidence. Many clinically-important questions go unstudied, and when they are addressed, research findings are often of dubious validity because weak study designs were used. The utility of syntheses of multiple studies addressing the same clinical question is undermined by variability in the methods and quality across individual studies. Additional funding for comparative effectiveness research will solve some of these problems, but not all.

Keywords:   Clinical trial, Experimental versus non-experimental designs, Case series, Hierarchy of clinical research designs, Knee Study (Moseley et al., 2002), Models of disease, Treatment effect, Non-inferiority trials, Placebo effect with treatment, Meta-analysis

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