Dr Data will see you now...
To some, evidence-based medicine is about providing the very best in clinical care to every patient. To others, it is a jingoistic term deployed liberally without real meaning. To a third grouping, it represents a stifling of an individual clinician’s freedom to practise. Whatever your viewpoint, the concept has hugely taken off in the last few decades and is here to stay.
To Dr Helen Stagg, a Chancellor’s Fellow in epidemiology and tuberculosis lead within the University’s Usher Institute, evidence-based medicine is about making the most of available data and information in order to guide decisions about patient care. It is also about the identification of areas in which evidence is weak and the careful and considered design of studies to fill those knowledge gaps.
“It is astounding in how many arenas I have come across ‘facts’ that have underpinned our clinical practice and research for decades which turn out to be mere assumptions,” Dr Stagg says. “We are currently, however, in an amazing era of opportunity for creative and accurate knowledge generation. The advent of Big Data, including the digitalisation of patient records across clinical care and use of new digital health technologies, has really changed things. The benefits that can arise from these tools to improve global health are immense.”
One avenue of Dr Stagg’s current research is in treatment optimisation and adherence in chronic conditions, including tuberculosis, where mobile health technologies look set to have a huge impact in the years to come. Her research interests also span antimicrobial resistance and Epstein Barr Virus, a human herpes virus associated with 1% of the world’s cancers. Inter-disciplinary population health approaches, she says, are vital for them all, and good data is critical for her team to develop the kind of evidence base on which viable policy decisions can be taken. “As an epidemiologist, high quality data sources fuel my research and provide endless exciting opportunities,” she notes. “Certain questions in population health are only becoming answerable now that we are in an era of Big Data.” It is not just about generating new data, however; Dr Stagg is also an expert in epidemiological approaches to knowledge synthesis, and has worked with national and international policy making bodies, particularly the UK’s National Institute for Health and Care Excellence, the European Centre for Disease Prevention and Control and the World Health Organization.
Nevertheless, there are notes of caution: “as Big Data sources become more accessible, we face challenges in ensuring that they are both accurate and contemporary, as well as in educating users how to appropriately interpret and analyse them, which must always be with an extensive understanding of the context in which collection occurred, the implications this has, and the limitations of any given dataset in terms of the conclusions that we can draw. Critically, we should have a huge sense of responsibility towards the individuals who contribute their data for medical research and to our funders, both ethically and in ensuring that we deliver work of the highest scientific quality. Only then can we justify using information that is selflessly contributed in order to improve care for future patients.”