Chapter 9: Conclusions
I have tried in this book to describe the field of HSR and consider its background, methods and applications. It has been written very much from a personal perspective in the hope that lessons for the future can be drawn. Medicine has always been considered as an art as well as a science and the best medicine is certainly both. Until the 1950s the criteria for diagnosis and treatment of a condition were usually based on pathophysiological knowledge and experiments, and the past experience of the doctor involved in a particular case. The demonstration of the effectiveness of streptomycin in the treatment of pulmonary tuberculosis in randomised controlled trials, carried out by the Medical Research Council group, led by Sir Austin Bradford Hill and published in 1948, changed all that and evidence-based medicine was born. Today it is expected that the effectiveness of any treatment will have been formally assessed before it is introduced. In the UK, the National Institute for Clinical Excellence is charged with the assessment of the cost-effectiveness of all new drugs before they are prescribed in the NHS and also provides reviews of and guidelines for all forms of management of particular conditions such as, for example, stroke, obesity or high blood pressure. The acceptance of formal, systematic evaluation of possible treatment and management of diseases and conditions is also of relatively recent origin.
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