All that glistens is not gold

There is a tendency among pre-hospital and emergency medicine practitioners to be “early adopters”. We have a love of gadgetry, perhaps because of our drive to “do” something to the patient at the time of their greatest need, to save them from the worst possible illnesses and injuries, and our occasional but still worryingly frequent frustration at our inability to do so. This makes us a gift to industry representatives seeking opportunities to have highly motivated clinicians to “trial” new equipment and to share their enthusiasm with others. This enthusiasm is often initiated by the unassailable logic presented by the salesman about why the equipment should work, perhaps supported by carefully selected “evidence”. This, however, is more likely to be based on small studies of poor quality, often using animal models or proxy outcomes rather than reliable clinical end points such as objectively measurable changes in morbidity and mortality, particularly when a piece of equipment is new to the market. Most clinicians are well aware that, before any drug can be used for patient care, it must be evaluated for safety and efficacy in well designed, adequately powered, ethically approved double-blind placebo-controlled randomised phase 1, 2 and 3 clinical trials. The results of these …