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Countries with major public health challenges do not always base their health-care decisions on the best available scientific evidence. Charles Shey Wiysonge tells Fiona Fleck how he and his colleagues are trying to change that.
Q: How did you become interested in medicine and public health?
A: Growing up in Cameroon I wanted to study mathematics and was drawn to complex equations and aeronautics, but people said I should study medicine, so I did. At medical school most students wanted to become clinical specialists, public health was not popular at all. After graduating, several things drew me to public health. I worked as a hospital physician and saw several outbreaks of measles. People used to say "don't count your children until measles have come and gone." Children were dying of measles every day. This experience eventually led me to work on immunization. Also, while working in internal medicine, there were several treatment options for hypertension and heart disease. I was not always sure which was the best. That's when I discovered evidence-based medicine. At that time - around the year 2000 - the Cochrane Collaboration started a new fellowship to train leaders in evidencebased medicine from low- and middleincome countries. I applied, became the first holder of the award and trained at the Cochrane Centre in Oxford.
Q: What is evidence-based medicine?
A: Research and other evidence are constantly changing and health-care professionals need to keep up with the latest developments so they can offer the interventions that are known to work and not those that are harmful or ineffective. There are many examples of unspeakable and unnecessary suffering resulting from the failure to take an evidence-based approach to clinical care. For example, in 1999 Cochrane researchers did a systematic review to find out whether drugs that inhibited massive calcium influx into cells reduce the risk of death or dependency after stroke. At the time, stroke patients were widely treated with calcium channel blockers. They found no evidence of a beneficial effect. Evidence-based medicine has been defined as the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients", although today, health-care professionals prefer the term "evidence-based health care" for a more holistic approach.
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