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POEMs: Patient-Oriented Evidence That Matters
- Allen F. Shaughnessy, PharmD; and
- David C. Slawson, MD
- Harrisburg Family Practice Residency, Harrisburg, PA 17105 University of Virginia, Charlottesville, VA 22908
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Fleming and DeMets [1] do an excellent job of pointing out the inadequacy of surrogate markers as appropriate outcomes for phase III trials. Surrogate markers are also inappropriate for clinical practice, yet they serve as the foundation on which many of the daily decisions in medicine are made.
Managed care is forcing clinicians to re-evaluate their decision making with well-focused questions on outcomes of care. Many clinicians try to deflect these queries as merely being based on finances. These questions, however, force us to examine our practices to determine whether our interventions truly are in the best interests of our patients.
When we try to decide whether a treatment offers a true clinical benefit, we should be able to turn to the literature to find “patient-oriented evidence that matters” (POEMs) [2]. As Fleming and DeMets point out, however, POEMs are unavailable to support most of what we do for patients. And when we do find clinically appropriate information, we tend to ignore it when it contradicts what we “know” is correct, a failing termed “reverse gullibility” [3].
A major change in our belief system must occur before our paradigm changes from basing patient care decisions on what should work, as established by effects on surrogate end points, to what does work. Designers of clinical trials are not the only ones who need to refocus their sights; all of medicine has to let go of the reductionistic approach to patient care (focusing on patients' component parts) that has been embraced for the past 80 years. Instead, we need to adopt the goal that medicine must provide care that has been shown, through actual study, to help patients live longer, healthier, more productive, symptom-free lives.
Allen F. Shaughnessy, PharmD
Harrisburg Family Practice Residency; Harrisburg, PA 17105
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
