Evidence about evidence

In this issue of the BJO (p 261), Siddiqui et al review the compliance of researchers with quality standards for evaluations of diagnostic test performance (DTP). “Standards” were originally set by the McMaster evidence based medicine (EBM) group1,2 and they have continued to evolve over recent years. Unfortunately, the standards appear to have had little impact since reviews of recent evaluations have shown that they tend to be of poor quality, in medicine generally and in ophthalmology and other specialties.3–6 The review of Siddiqui et al confirms this gloomy picture.

In contrast, during the same period, there has been substantial improvement in the quality and reporting of evaluations of the effectiveness of treatments. Why has research to evaluate DTP not benefited in a similar way from the EBM “movement”? Perhaps improving the quality of research about effectiveness was seen as a priority because it was perceived to be important to patients—the “bit” of health care that makes them better—or because the resources wasted from using treatments that don’t work (and not using ones that do) was much easier for …