Editorial
Álvaro Nagib Atallah* * MD, PhD, MCE - Scientific Director of the Associação Paulista de Medicina
Evidence-based medicine in Brazil
The importance of medical practice based on the best existing level of scientific evidence is today no longer under discussion in developed countries and within the most up-to-date medical schools.
Evidence-based medicine is already included among the required concepts and premises of entities such as the British Royal College, American College of Physicians (vide: ACP Club Journal), US Agency for Research and Health Policy, American Medical Association, World Health Organization, as well as governments and research agencies in the United States, Canada, England, Australia, Norway and Sweden.
In Brazil, in addition to the Associação Paulista de Medicina, the Conselho Federal de Medicina has established parameters for medicine based on scientific evidence to maintain coherence with its commitment to ethical practice. The new President of the Associação Médica Brasileira, Prof. Dr. Eleuses Paiva, has already declared that his proposed work program will include the creation of a consensus around the framework of evidence-based medicine. Such an idea of seeking efficiency in consonance with ethics, based on valid prior scientific evaluation of every diagnostic, therapeutic or prophylactic procedure, is already consolidated in our environment. The present consolidation may be taken as greatly honoring the professional and academic ranks within Brazilian Medicine, which have been distinguishing themselves internationally in the process of continuing education based on scientific acceptance of modern methods in clinical epidemiology.
With the recognition of the importance of this knowledge having been consolidated, how can we maintain the up-to-date practice of evidence-based medicine?
The Associação Paulista de Medicina has already made a great step forward in this sense. Four years ago, the television program "APM na TV, Medicina Baseada em Evidências" was created and broadcasting began throughout Brazil and to Mercosul on an open UHF channel, via satellite dish and cable TV (NET, TVA, Multicanal). This medical teaching activity grounded in evidence-based medicine drew international attention because of its pioneering spirit and originality, and was the subject of material in The Lancet (August 28, 1998; 352:463). Through this medium, health professionals in Brazil and Mercosul have been able to receive, in their homes and without payment, knowledge that is precious for these professionals and that has direct benefits for the health of the population.
How does the program work? Recognized authorities on subjects of interest to the medical profession are invited to present their knowledge on the program, orientated to avoid personal opinions and confine their affirmations to the best scientific evidence available. Questions related to characteristics and sequence of teaching are discussed with the Director of the program, who is a general clinician trained in clinical research. The invited specialist is then interviewed by doctors with knowledge of the basic concepts of evidence-based medicine. The main references are displayed at the foot of the video. The Brazilian Cochrane Center places its review services at the disposition of the invitees. In this manner, around 750 themes, covering the interests of the majority of medical professionals, have been recorded on video and successfully transmitted throughout the country during these four years. Around 200 chair-holding professors from the best schools and hundreds of other researchers of no lesser importance have provided relevant services to the profession and Brazilian society using their knowledge.
Four opinion polls, the latest of which was the most extensive, with 2500 questionnaires answered, have revealed that 97% of doctors consider the program to be important for keeping their own knowledge up-to-date. Ninety-five percent of the responses indicated that the program was good or very good (an index repeated in all four polls). Around 10% watch the program every week and around 65% watch it at least once a month. Eighty percent of doctors are able to receive the channel that broadcasts the program.
Several countries have manifested interest in the program. In March 1999 we were invited by the Directors of the Cochrane Center of the University of Freiburg in Germany to present the concepts of the program, which they intend to reproduce in the same format in that country.
In this way, a simple, cheap and practical manner has been devised for putting the best in medical information at the disposition of health professionals via the Associação Paulista de Medicina, with benefits for health professionals, for patients and for society.
The next steps in the refinement of the program should be the publicizing of the results from the consensus being developed as a collaboration between the Universities and Medical Associations. Programs aimed to lay people should be developed that take the knowledge of what has been scientifically proven to work to the patients and the population in general, who should be the focus of refinements in the activities of health professionals. Political support will thereby accrue, and, more than ever, such support is seen as fundamental in allowing scenarios of healthcare to be modified via science, ethics and efficiency.
Publication Dates
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Publication in this collection
04 Nov 1999 -
Date of issue
July 1999
