Doctors' self rating of skills in evidence based medicine

Aug 1, 2002 EDITOR-In April the BMJ published an editorial (gently) deploring Australian general practitioners' lack of knowledge about the terminology of evidence based medicine. 1 Ironically, a month earlier it published an editorial on the heart outcomes prevention evaluation (HOPE study), where the only evidence cited to support the statement that ramipril substantially decreased the risk of stroke and transient ischaemic attack was that treatment produced a 32% reduction in relative risk. 2 In fact, reference to the original paper shows that the absolute risk reduction for all strokes was 1.5%; in other words, 66 patients would have to take ramipril for 4.5 years to prevent one stroke, which may or may not be regarded as a clinically important effect. 3 In a journal like the BMJ, which is such a champion of evidence based medicine, surely readers have a right to expect that editorials about recent trials should contain a critical appraisal of the evidence.