Cochrane Reviews: What They Cannot For for you - Walter Ling MD - ISAM 2013 Kuala Lumpur

Walter Ling MD
Integrated Substance Abuse Programs (ISAP) UCLA
 


What Cochrane Reviews Cannot Do
A Cochrane Review can only inform
Cochrane Reviews can't transform
Bulk of Cochrane reviews use data generated in the US by US researches
NIDA supports 80% of addiction research world wide
Few US Physicians even know about Cochrane Reviews
Only 1 state gives free access to it's residents: Wyoming

Why Cochrane Reviess are not used in the US
-US medical practice standards are local
-If you get sued in court, the judge is not going to ask these questions, but ask if you are doing what your neighbours are doing down the street
-No National health care system
-emphasis on tradition and personal experience
-Cochrane not 'made in US'
-ideology and societal attitudes and values over scientific evidence - preoccupation with  detoxification, insistence on abstinence (temperance movement, distrust in agonist pharmacotherapy, distrust in harm reduction strategies
-early leadership role widely followed by other countries.
What I'm saying is that just because there is evidence it doesn't mean people will change. There needs to be a process.  If we look at changes and how we become good physicians, we have to have something as part of the treatment philosophy.

US Health Report Car: Shorter Live, Poorer Health
- last among peer nations in health status

Cochrane Reviews cannot help do better research; better research can improve Cochrane reviews.

Does Opiate Substitution Treatment Reduce HIV Transmission -Michael Farrow - ISAM 2013 Kuala Lumpur

This was an excellent presentation. I took some pictures of a few of the slides but overall just enjoyed listening to this presentation.  This gives an overview of the kind of information available. I certainly encourage the actual reading of the relevant Cochrane reviews.  I didn't need to know about the benefit of OAT personally, but was impressed with the evidence supporting ART.

Translating Cochrane Reviews to practice - Linda Gowing - ISAM 2013 - Kuala Lumpur

Systematic reviews are focussed, respond to a specific question
Grading - assesses the strength of evidence - high, moderate, low, very low

Eg. Buprenorphine vers adrenergic - completion of treatment

Cochrane Review -What They Have to Offer Addiction Medicine -Robert Ali

The Cochrane Reviews were developed to review scientific research asking the question when do we have enough science to make a right decision.  Do we have enough information or do we need more.
They help the busy clinician understand scientifically what works. Theres also information about prevention.



Brief Interventions have been studied and shown beneficial. There are major studies to date reviewing existing research in vital areas of drug and alcohol treatment.
CDAG Authors - european centric area - however there are 11% asia - concern for Cochrane Reviews is the generalizability so we're looking forward to
more reviews and studies outside of America.

Categorization of Interventions - this methodology is especially helpful for busy clinicians




40% Opiate effectiveness
16% Likely beneficial
When a Cochrane Review has been done there's a duty of the Cochrane Reviews to return a few years later and see what has changed.
Cochrane provides standardized systematic way to review evidence, points to what works, also identifies what doesn't work, importantly point to areas where further work is required.
(These are my rough notes and I apologize for any mistakes, they're just an overview. )
I had read a couple of Cochrane Reviews and frankly didn't know what their overall significance was . That brought me to this course, as one of four symposium occurring at this time.  I'd noted they were very good reviews. Indeed I referred to one as evidence  in a major court case, justifying the treatment which I'd been using, but had been called upon to explain by a colleague for the opposing side. Naturally I appreciated the Cochrane Reviews that day. This presentation helped me understand the Reviews better. Now I'm planning to consider them a first source.  When there was less overall information out there, when I began practice a quarter century ago, as a clinician I loved the 'Review" section best in the NEJM and CMAJ and other major medical journals.  I tend only to look at the original research when something doesn't fit with what I'm seeing clinically. Now that I've gone mostly to the internet for information I've missed these 'review' articles and can see that the Cochrane Reviews are the obvious replacement of that previous helpful read in the paper journals. - W. Hay
www.cochranelibrary.com