Confronting therapeutic ignorance

This week’s BMJ includes the first of a series of articles on areas of practice where clear and robust evidence is lacking, and where uncertainty exists about management.1

Our failure to confront uncertainty about the effects of treatment has resulted in the suffering and death of patients, sometimes on a massive scale. Hundreds of thousands of people died prematurely because of failure to tackle uncertainty about the effects on mortality of prophylactic use of antiarrhythmic drugs in myocardial infarction.2 3 When the CRASH trial assessed uncertainty about the effects of corticosteroids in acute traumatic brain injury, it revealed that this treatment had been killing people for more than three decades.4 5 When widespread uncertainties about the effects of caffeine used to reduce episodes of apnoea in premature babies were assessed more than 30 years after the treatment had been introduced, it turned out that this simple treatment reduces …