Dear All CSS Members:
Enclosed is a reprint of an article by Ioannidis (click here for article). It highlights why most of the evidence upon which we base our decisions is so weak. Frankly, most of our retrospective, cohort studies which are level 4 are nothing more than an inaccurate snapshot of what we think we achieve with our surgery. Thus, if value is our goal, we really can't distinguish which treatment is best. Even Level I, Prospective Randomized studies (which are difficult to do in surgery) are often proven wrong by similar studies. Thus, if our mission is to provide the best evidence for our treatment in order to deliver value, we are standing on very unstable ground with the evidence we have. I thought this would be of interest, and I'm just saying........maybe we can do better.
Jon JP Warner, MD
Chief, MGH Shoulder Service
Boston Shoulder Institute
Founder, The Codman Shoulder Society