Centre for Evidence-Based Medicine
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The Centre for Evidence-Based Medicine (CEBM), based in the Nuffield Department of Primary Care Health Sciences at the
University of Oxford , mottoeng = The Lord is my light , established = , endowment = £6.1 billion (including colleges) (2019) , budget = £2.145 billion (2019–20) , chancellor ...
, is an academic-led centre dedicated to the practice, teaching, and dissemination of high quality
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
to improve healthcare in everyday clinical practice. CEBM was founded by
David Sackett David Lawrence Sackett (November 17, 1934 – May 13, 2015) was an American-Canadian physician and a pioneer in evidence-based medicine. He is known as one of the fathers of Evidence-Based Medicine. He founded the first department of clinical ...
in 1995. It was subsequently directed by Brian Haynes and
Paul Glasziou Paul Philip Glasziou (born 21 May 1954) is an Australian academic physician known for his research in evidence-based medicine. He is Professor of Evidence-Based Medicine at Bond University, where he is also Director of the Faculty of Health Sc ...
. Since 2010 it has been led by Professor Carl Heneghan, a clinical epidemiologist and general practitioner. There are currently over 25 active staff and honorary members of the CEBM. The staff include clinicians, statisticians, epidemiologists, information specialists, quantitative and qualitative researchers.


Teaching and degrees

CEBM is the academic lead for Oxford University's Graduate School in Evidence-Based Healthcare, together with the university's
Department of Continuing Education Oxford University Department for Continuing Education (OUDCE) is a department within the University of Oxford that provides continuing education mainly for part-time and mature students. It is located at Rewley House, Wellington Square, and at ...
. The Graduate School includes a MSc in Evidence-Based Health Care and a
DPhil A Doctor of Philosophy (PhD, Ph.D., or DPhil; Latin: or ') is the most common degree at the highest academic level awarded following a course of study. PhDs are awarded for programs across the whole breadth of academic fields. Because it is a ...
in Evidence-Based Health Care, along with a range of short courses, including a course on the History and Philosophy of Evidence-Based Healthcare which was developed by
Jeremy Howick Jeremy Howick is a Canadian-born, British residing clinical epidemiologist and philosopher of science. He researches evidence-based medicine, clinical empathy and the philosophy of medicine, including the use of placebos in clinical practice a ...
and
Iain Chalmers Sir Iain Geoffrey Chalmers (born 3 June 1943) is a British health services researcher, one of the founders of the Cochrane Collaboration,evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
. The conference is organised in collaboration with the
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
. Themes for the conference include Improving the Quality of Research; disentangling the Problems of Too Much and Too Little Medicine; transforming the Communication of Evidence for Better Health; training the Next Generation of Leaders and translating Evidence into Better-Quality Health Services.


Notable projects


Levels of evidence

CEBM has developed a widely adopted systematic hierarchy of the quality of medical research evidence, named the
levels of evidence A hierarchy of evidence (or levels of evidence) is a heuristic used to rank the relative strength of results obtained from scientific research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 8 ...
.
Systematic reviews A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...
of randomised clinical trials (encompassing
homogeneity Homogeneity and heterogeneity are concepts often used in the sciences and statistics relating to the uniformity of a substance or organism. A material or image that is homogeneous is uniform in composition or character (i.e. color, shape, siz ...
) are seen as the highest possible level of evidence, as full assessment and aggregated synthesis of underlying evidence is possible.


Tamiflu

In collaboration with the
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
, Carl Heneghan and team found no evidence that Tamiflu helped to reduce complications of influenza. This has become a controversial topic, as the United Kingdom government spend £473 million () on the purchase of
Tamiflu Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. Many medical organizations recommend it in people who have complications or are at hig ...
, despite the systematic review claiming to find no evidence for the effectiveness of it.


Sports products

A systematic review conducted in 2012 discovered a very little effect of carbohydrate drinks on sport performance of the general population. This work formed part of a joint investigation with
BBC Panorama ''Panorama'' is a British BBC Television current affairs documentary programme. First broadcast in 1953, it is the world's longest-running television news magazine programme. ''Panorama'' has been presented by many well-known BBC presenters, ...
and the ''
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
''. A linked article published in the BMJ reported a "striking lack of evidence" to back up claims for popular sports brands. A further analysis of a broad range of sports products showed that the evidence for many sports products is poor quality and insufficient to inform the public about the benefits and harms of the products.


Self care

Systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
and individual patient data meta analysis research in the centre has shown that, even with little training, people on oral anticoagulation (
Warfarin Warfarin, sold under the brand name Coumadin among others, is a medication that is used as an anticoagulant (blood thinner). It is commonly used to prevent blood clots such as deep vein thrombosis and pulmonary embolism, and to prevent strok ...
) can successfully self-monitor, and even self-manage their disease in the community. Patients capable of self-monitoring and self-adjusting therapy have fewer
thromboembolic Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thr ...
events and lower mortality than those who self-monitor alone. In 2014, Carl Heneghan along with Alison Ward became directors of a
World Health Organization Collaborating Centre World Health Organization collaborating centres are institutions that work with the World Health Organization (WHO) in disciplines such as occupational health, food safety, and communicable disease prevention. There are over 700 such centres across ...
for Self-Care in
Non-communicable disease A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, os ...
.


AllTrials

The centre is one of the co-founders of the
AllTrials AllTrials (sometimes called All Trials or AllTrials.net) is a project advocating that clinical research adopt the principles of open research. The project summarizes itself as "All trials registered, all results reported": that is, all clinical tr ...
campaign, which has been influential in ensuring that the results of all clinical trials are registered and reported in full.


Diagnostic technologies and reasoning

The centre has a strong diagnostic theme which includes assessing novel diagnostic technologies relevant to improving the diagnosis of disease in primary care and also to improving diagnostic reasoning. In 2015, the centre produced a report for the
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
on
antimicrobial resistance Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. ...
diagnostics, which highlighted the considerable number of new diagnostic technologies in development to underpin rational prescribing of
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s.


COMPare project

In 2015 the COMPare project was launched, addressing outcome switching in clinical trials. The project systematically checks every trial published in the top five medical journals, to see if they have misreported their findings, comparing each clinical trial report against its registry entry. The project has found that some trials report their outcomes perfectly, but for many others outcomes specified in the registry entry were never reported. The updates to the trials are updated live on the COMPare website. The project highlights how researchers are duped by the common practice in clinical trial reporting of "outcome switching".


Adverse events

In March 2016, research at the centre systematically identified 353 medicinal products withdrawn worldwide because of adverse drug reactions, assessed the level of evidence used for making the withdrawal decisions, and found that only 40 drugs were withdrawn worldwide. Withdrawal was significantly less likely in Africa than in other continents. Furthermore, in 47% of the 95 drugs for which death was documented as a reason for withdrawal, more than two years elapsed between the first report of a death and withdrawal of the drug.


Notable associates

Notable associates of the centre include: *
Ben Goldacre Ben Michael Goldacre (born 20 May 1974) is a British physician, academic and science writer. He is the first Bennett Professor of Evidence-Based Medicine and director of the Bennett Institute for Applied Data Science at the University of Oxford ...
, Senior clinical
Research fellow A research fellow is an academic research position at a university or a similar research institution, usually for academic staff or faculty members. A research fellow may act either as an independent investigator or under the supervision of a pr ...
*
Iain Chalmers Sir Iain Geoffrey Chalmers (born 3 June 1943) is a British health services researcher, one of the founders of the Cochrane Collaboration,Muir Gray Sir John Armstrong Muir Gray is a British physician, who has held senior positions in screening, public health, information management. and value in healthcare. He is currently the Chief Knowledge Officer for EXi, a digital health therapeutic ...
* Professor Rod Jackson,
University of Auckland , mottoeng = By natural ability and hard work , established = 1883; years ago , endowment = NZD $293 million (31 December 2021) , budget = NZD $1.281 billion (31 December 2021) , chancellor = Cecilia Tarrant , vice_chancellor = Dawn F ...


References

{{coord missing, Oxfordshire 1995 establishments in England Educational institutions established in 1995 Research institutes of the University of Oxford
Evidence-Based Medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
Medical and health organisations based in England English medical research Evidence-based medicine