Salam All,
Mohammad Al-Fayez ain't a soccer player nor a singer, hence most likely you have not heard of him.
Mohammad has become the first ever medical student at University of Leicester to complete an intercalated PhD in two years, while still an undergraduate and without first doing a BSc in the same subject.
http://www2.le.ac.uk/ebulletin/features/2000-2009/2007/09/nparticle.2007-09-03.3118764063
Congratulations to Mohammad Al-Fayez. A role model for Saudi Students everywhere. I wish he receives 1% of the media coverage received by a soccer player who hasn't finished elementary school. Just to show our youth that there are successful Saudi students and researchers across the globe to stimulate them to exceel in their studies.
Regards,
Sohail Bajammal
Monday, January 14, 2008
Misconceptions about EBM
This is a copy of an email sent to ebmJeddah Yahoogroups on March 6, 2005 in response to an article published in Al Watan Newspaper by Prof. H. Alzahrani downgrading the value of EBM.
-----------------------------------------------------
Dear All,
Objections to EBM is not new. Clearly, Prof. Al Zahrani is not the first one to raise this point with objections to EBM. However, the new thing is the harsh reply and aggressiveness of labelling all those who practice EBM as "ilmani". I hope that this labelling will not go further more. This sort of judgemental opinion is the norm in our culture, especially in KAAU where I graduated. You are either with me or against me. I think we should deal with the dispute in a more reasonable friendly way.
I think the main problem is the mis-understanding of EBM and narrwoing it down to "research-based medicine". I will not repeat what is written in the literature (an example attached as a pdf file). However, I will summarize the article in 4 points. EBM is based on 4 domains: 1. Clinical state and circumstances. 2. Research evidence. 3. Patients preferences. and 4. Clinical expereince of the physician. It is very obvious that the bulk of Prof. Al Zahrani's article is focued on "research evidence" ignoring the remaining 3 domains of the current model of EBM.
As Prof. Al Zahrani clearly indicated that Muslim Scholars initiated the principles of Modern Medicine. However, he did not mention that that excellence was based on applying the proper principles of scientific research methodology and experiments. It seems that the word "research" was intentionally ignored. Thus, Muslim Scholars are indeed the first to lay the foundations of EBM. For the years that followed those golden years, we all went into dormant state and were improting the evidence. I hope we are wakening up now to re-apply the principles of scientific methodology. So I hope we are not "ilmanis" and not "extremists" on the other hand.
EBM is difficult to practice not because it is a rocket science but because it is time consuming. It entails being up to date with the current medical literature. To practice EBM, you have to be flexible in agreeing to change your practice based on the current evidence. We all now that behavior modification is one of the most difficult challenge for humans. Basically, to practice EBM means that you will have less time for the private sector. This explains why EBM does not appeal to some.
If Prof. Alzahrani's point was we should do our own research rather than utilizing (importing) the available evidence. I totally agree with him. RCTs and other levels of evidence done elsewhere cannot be always extrapolated and generalized to different ethnic groups and population. Furthermore, from Islamic point of view, we have to utilize economic analyses (cost-effectiveness, cost-utility and cost-benefit analyses) to decide what is the best cost-effective treatment option for a given clinical problem to avoid wasting unnecessary money. In order to make an informed decision, we have to conduct our own economic analyses.
Finally, I have few questions for Prof. Al Zahrani: "How should we practice Medicine?". Should we ignore textbooks? (At the end of the day, textbooks are based on research evidence and clinical experience of the authors). Should we ignore patients preferences?. Should we ignore the clinical state of the problem and use a cook book Medicine for every single patient?. If we cannot ignore these questions, then we should practice EBM!
Regards,
Sohail Bajammal
-----------------------------------------------------
Dear All,
Objections to EBM is not new. Clearly, Prof. Al Zahrani is not the first one to raise this point with objections to EBM. However, the new thing is the harsh reply and aggressiveness of labelling all those who practice EBM as "ilmani". I hope that this labelling will not go further more. This sort of judgemental opinion is the norm in our culture, especially in KAAU where I graduated. You are either with me or against me. I think we should deal with the dispute in a more reasonable friendly way.
I think the main problem is the mis-understanding of EBM and narrwoing it down to "research-based medicine". I will not repeat what is written in the literature (an example attached as a pdf file). However, I will summarize the article in 4 points. EBM is based on 4 domains: 1. Clinical state and circumstances. 2. Research evidence. 3. Patients preferences. and 4. Clinical expereince of the physician. It is very obvious that the bulk of Prof. Al Zahrani's article is focued on "research evidence" ignoring the remaining 3 domains of the current model of EBM.
As Prof. Al Zahrani clearly indicated that Muslim Scholars initiated the principles of Modern Medicine. However, he did not mention that that excellence was based on applying the proper principles of scientific research methodology and experiments. It seems that the word "research" was intentionally ignored. Thus, Muslim Scholars are indeed the first to lay the foundations of EBM. For the years that followed those golden years, we all went into dormant state and were improting the evidence. I hope we are wakening up now to re-apply the principles of scientific methodology. So I hope we are not "ilmanis" and not "extremists" on the other hand.
EBM is difficult to practice not because it is a rocket science but because it is time consuming. It entails being up to date with the current medical literature. To practice EBM, you have to be flexible in agreeing to change your practice based on the current evidence. We all now that behavior modification is one of the most difficult challenge for humans. Basically, to practice EBM means that you will have less time for the private sector. This explains why EBM does not appeal to some.
If Prof. Alzahrani's point was we should do our own research rather than utilizing (importing) the available evidence. I totally agree with him. RCTs and other levels of evidence done elsewhere cannot be always extrapolated and generalized to different ethnic groups and population. Furthermore, from Islamic point of view, we have to utilize economic analyses (cost-effectiveness, cost-utility and cost-benefit analyses) to decide what is the best cost-effective treatment option for a given clinical problem to avoid wasting unnecessary money. In order to make an informed decision, we have to conduct our own economic analyses.
Finally, I have few questions for Prof. Al Zahrani: "How should we practice Medicine?". Should we ignore textbooks? (At the end of the day, textbooks are based on research evidence and clinical experience of the authors). Should we ignore patients preferences?. Should we ignore the clinical state of the problem and use a cook book Medicine for every single patient?. If we cannot ignore these questions, then we should practice EBM!
Regards,
Sohail Bajammal
Medical Research in the Middle East: is there something missing?
This is a copy of an email I sent to the Arab Federation of Evidence-Based Medicine Mailing list on September 19, 2007 in response to an inquiry about what is missing for medical research to florish in our region.
-------------------------------------------
Dear All,
Thank you very much for initiating and contributing to this important inquiry and discussion that is of interest for all members of the group, hence we joined the Arab Federation of Evidence-Based Medicine aiming for the best for our region. I guess we have lots of obstacles across the arab countries, some common to all countries and some are country-specific. I think the first step would be to differentiate evidence-based medicine (as the utilization and application of the available evidence to patient care) and research (i.e., doing the research). The way I look at the problem at a broader perspective is splitting research as a whole into planning, conducting and dissemination. I will go into each phase and the related obstacles in my opinion, posting some questions to stimulate other members to contribute.
1. Research Planning:
a. Needs Assessment: Do we need to do research in our region? What type of research? Therapeutic/experimental randomized trials, prospective prognostic cohorts, or regional cross-sectional studies? Can we just use (import) research done in other regions since we import other things as well? I am just asking.
b. Public Awareness and Acceptance: This the first point of a vicious cycle. Since we, currently, have attempts of experimental research in our region that sometimes are not strictly controlled by ethics committees, the public doubts the credibility of some researches. Some cultures would not even accept the idea of being treated based on flipping a coin! So we need to have more health education regarding this aspect. As far as the public is not interested, no national or private funding would be readily available.
c. Research Question: I agree with Dr. Attia, this is one of the crucial steps. Ideally, this should be posed by one person, brought forward to his/her research group for editing and reformulating. Then the group as whole (clinicians, research methodologist, biostatisticians, research assistants) works through the process from formulating the question, editing it, writing the protocol, revising it, re-writing it and so in. Definitely, they don't need to be in a physical group, lots of these stuff can be done virtually by emails or tele-conferencing (which is expensive but cheaper than conducting an ill-designed study and cheaper than traveling).
d. Collaboration, Interest and Subspecialty: I think this is another major obstacle in our region. Even if some researches are conducted by research groups in our region, there is less collaboration between different research groups. For example, if a group (which consists of gynecologists, researches, biostatisticians) is conducting an RCT in gynecology, it is very unlikely that they will ask the help of a gynecologist researcher if he/she is not in the vicinity of that group (either because they don't know that one exists or they like to deal with everything internally). I guess one of the nice features of this mailing list that it may act as a medium for dissemination of research expertise in our Arab world.
e. Research Funding: Governments, non-profit organizations, and private sectors funding is crucial for the success of research. Either way, this should be governed by a national body that regulates and monitors the conduct of research in each country; just like a national body that regulates the practice of medicine.
f. Ethics Boards: Availability and diversity of background of members.
2. Research Conduction:
a. Research Assistants: As we have done a great job in conducting lots of evidence-based medicine courses, we may start thinking of conducting more courses for nurses and other allied health care professionals to qualify them as research assistants (say to work as part time initially). As we all know, it is difficult to combine day-to-day running of research and day-to-day clinical practice.
b. Research Instruments/Scales: This point can be considered in the planning part. This is another major difficulty. The availability of reliable, validated Arabic measurement instruments, e.g., SF-36, is a major obstacle for conducting research. As we know, we cannot just translate the English version of SF-36 into Arabic, this need to go through vigorous process of validation and re-validation. This process by itself needs lots of research.
c. Recruiting Centers Collaboration: Professional education for colleagues that research is team-work, and that even if your name does not show up in the 5-6 names in the authors list, you are part of the list of researchers by recruiting patients to multi-center studies and you are contributing to the knowledge base of the world.
d. Research Centers: Although studies can be conducted across the country in different hospitals, a regional research center equipped with sophisticated data management facilities and experience personnel can help facilitate this.
3. Research Results Dissemination:
a. Medical Writing and Mentorship: In addition to EBM courses, we can do Research Methodology courses, Research Assistants courses and Medical Writing courses. However, one of my supervisors told me that better writing comes by mentorship. The more you write, the more your mentor corrects and guides you, the better you will be and the better the end result of research results report and dissemination would be. I believe that this is another fundamental aspect of research that we need to enforce. Mentorship, mentorship, mentorship.
b. Media Collaboration: Dissemination of the results of our own research in our regional TV, newspapers, and magazines will help shed light and educate the public on local research and the fact that we do do research.
c. Research Conferences: Both regional and national, specialty-specific conferences help to encourage other colleagues in contributing.
4. First of All, The Basics:
a. Improving Medical Schools Curriculum: Put more emphasis on research methodology and evidence-based medicine and the facts that research is not equal community medicine rotation. It is beyond that.
b. Encouraging Medical Students: By contributing to different aspects of research: planning, conducting or dissemination, to give them a hand-on exposure to research.
c. Research Consideration during Residency Application: If more emphasis is focused on research experience for medical students when they apply for residency and more weight is given for those with good exposure to research, definitely this will improve the overall attitude towards research and its importance.
Regards,
Sohail Bajammal
-------------------------------------------
Dear All,
Thank you very much for initiating and contributing to this important inquiry and discussion that is of interest for all members of the group, hence we joined the Arab Federation of Evidence-Based Medicine aiming for the best for our region. I guess we have lots of obstacles across the arab countries, some common to all countries and some are country-specific. I think the first step would be to differentiate evidence-based medicine (as the utilization and application of the available evidence to patient care) and research (i.e., doing the research). The way I look at the problem at a broader perspective is splitting research as a whole into planning, conducting and dissemination. I will go into each phase and the related obstacles in my opinion, posting some questions to stimulate other members to contribute.
1. Research Planning:
a. Needs Assessment: Do we need to do research in our region? What type of research? Therapeutic/experimental randomized trials, prospective prognostic cohorts, or regional cross-sectional studies? Can we just use (import) research done in other regions since we import other things as well? I am just asking.
b. Public Awareness and Acceptance: This the first point of a vicious cycle. Since we, currently, have attempts of experimental research in our region that sometimes are not strictly controlled by ethics committees, the public doubts the credibility of some researches. Some cultures would not even accept the idea of being treated based on flipping a coin! So we need to have more health education regarding this aspect. As far as the public is not interested, no national or private funding would be readily available.
c. Research Question: I agree with Dr. Attia, this is one of the crucial steps. Ideally, this should be posed by one person, brought forward to his/her research group for editing and reformulating. Then the group as whole (clinicians, research methodologist, biostatisticians, research assistants) works through the process from formulating the question, editing it, writing the protocol, revising it, re-writing it and so in. Definitely, they don't need to be in a physical group, lots of these stuff can be done virtually by emails or tele-conferencing (which is expensive but cheaper than conducting an ill-designed study and cheaper than traveling).
d. Collaboration, Interest and Subspecialty: I think this is another major obstacle in our region. Even if some researches are conducted by research groups in our region, there is less collaboration between different research groups. For example, if a group (which consists of gynecologists, researches, biostatisticians) is conducting an RCT in gynecology, it is very unlikely that they will ask the help of a gynecologist researcher if he/she is not in the vicinity of that group (either because they don't know that one exists or they like to deal with everything internally). I guess one of the nice features of this mailing list that it may act as a medium for dissemination of research expertise in our Arab world.
e. Research Funding: Governments, non-profit organizations, and private sectors funding is crucial for the success of research. Either way, this should be governed by a national body that regulates and monitors the conduct of research in each country; just like a national body that regulates the practice of medicine.
f. Ethics Boards: Availability and diversity of background of members.
2. Research Conduction:
a. Research Assistants: As we have done a great job in conducting lots of evidence-based medicine courses, we may start thinking of conducting more courses for nurses and other allied health care professionals to qualify them as research assistants (say to work as part time initially). As we all know, it is difficult to combine day-to-day running of research and day-to-day clinical practice.
b. Research Instruments/Scales: This point can be considered in the planning part. This is another major difficulty. The availability of reliable, validated Arabic measurement instruments, e.g., SF-36, is a major obstacle for conducting research. As we know, we cannot just translate the English version of SF-36 into Arabic, this need to go through vigorous process of validation and re-validation. This process by itself needs lots of research.
c. Recruiting Centers Collaboration: Professional education for colleagues that research is team-work, and that even if your name does not show up in the 5-6 names in the authors list, you are part of the list of researchers by recruiting patients to multi-center studies and you are contributing to the knowledge base of the world.
d. Research Centers: Although studies can be conducted across the country in different hospitals, a regional research center equipped with sophisticated data management facilities and experience personnel can help facilitate this.
3. Research Results Dissemination:
a. Medical Writing and Mentorship: In addition to EBM courses, we can do Research Methodology courses, Research Assistants courses and Medical Writing courses. However, one of my supervisors told me that better writing comes by mentorship. The more you write, the more your mentor corrects and guides you, the better you will be and the better the end result of research results report and dissemination would be. I believe that this is another fundamental aspect of research that we need to enforce. Mentorship, mentorship, mentorship.
b. Media Collaboration: Dissemination of the results of our own research in our regional TV, newspapers, and magazines will help shed light and educate the public on local research and the fact that we do do research.
c. Research Conferences: Both regional and national, specialty-specific conferences help to encourage other colleagues in contributing.
4. First of All, The Basics:
a. Improving Medical Schools Curriculum: Put more emphasis on research methodology and evidence-based medicine and the facts that research is not equal community medicine rotation. It is beyond that.
b. Encouraging Medical Students: By contributing to different aspects of research: planning, conducting or dissemination, to give them a hand-on exposure to research.
c. Research Consideration during Residency Application: If more emphasis is focused on research experience for medical students when they apply for residency and more weight is given for those with good exposure to research, definitely this will improve the overall attitude towards research and its importance.
Regards,
Sohail Bajammal
Collaboration, mentorship, networking, etc.
A copy of an email I sent to the Arab Federation of Evidence-Based Medicine on October 4, 2007
----------------------------------------
Dear List Members,
Assalamu Alaikum WR WB.
I would like to start a discussion thread related to research and evidence-based practice for discussion among the list members. Although some aspects of the discussion may offend some members, but I believe that the identification of obstacles and the frank open discussion of these obstacles are important steps to solve these problems. I hope that this discussion will not be viewed as pessimistic. On the contrary, I think once we identify the problem and lay down the potential solutions, we will have an optimistic picture to solve the problem.
Although what I will be discussing happened to me, but I think it is a general theme in our region. For those of us who have spent time abroad, they will recall how accessible and helpful (most of the time) their supervisors and mentors in the western countries were when they were studying abroad. Personally, I have emailed people (in western countries) who I have never met or known personally for career advice or research problems. Most of the time, I would receive a PROMPT elaborate reply with detailed suggestions and, sometime, they would volunteer a phone number to contact them for further follow-up.
On the other hand, I contacted people in our region asking for their advice. Most of the time, I would receive complete silence and ignorance. I have tired sending emails to their different email addresses or through their secretary. My attempts are usually fruitless.
My questions are:
1. Is this a personal experience?
2. Have other members in the group faced the same problem?
3. What is the reason for this phenomenon, if it does exit?
4. Can we solve this problem?
5. Can the Arab Federation of EBM start an initiative in the region to encourage collaboration, mentorship and networking?
6. Would a list for volunteer mentors with their contact information help to solve this problem?
7. Would the Arab Federation of EBM consider maintaining such a list to encourage young doctors to pursue research and ensure that they are mentored by interested researchers and scholars?
I hope that this message will trigger some calm constructive discussions leading to some solutions to encourage research in our region.
Regards,
Sohail Bajammal
----------------------------------------
Dear List Members,
Assalamu Alaikum WR WB.
I would like to start a discussion thread related to research and evidence-based practice for discussion among the list members. Although some aspects of the discussion may offend some members, but I believe that the identification of obstacles and the frank open discussion of these obstacles are important steps to solve these problems. I hope that this discussion will not be viewed as pessimistic. On the contrary, I think once we identify the problem and lay down the potential solutions, we will have an optimistic picture to solve the problem.
Although what I will be discussing happened to me, but I think it is a general theme in our region. For those of us who have spent time abroad, they will recall how accessible and helpful (most of the time) their supervisors and mentors in the western countries were when they were studying abroad. Personally, I have emailed people (in western countries) who I have never met or known personally for career advice or research problems. Most of the time, I would receive a PROMPT elaborate reply with detailed suggestions and, sometime, they would volunteer a phone number to contact them for further follow-up.
On the other hand, I contacted people in our region asking for their advice. Most of the time, I would receive complete silence and ignorance. I have tired sending emails to their different email addresses or through their secretary. My attempts are usually fruitless.
My questions are:
1. Is this a personal experience?
2. Have other members in the group faced the same problem?
3. What is the reason for this phenomenon, if it does exit?
4. Can we solve this problem?
5. Can the Arab Federation of EBM start an initiative in the region to encourage collaboration, mentorship and networking?
6. Would a list for volunteer mentors with their contact information help to solve this problem?
7. Would the Arab Federation of EBM consider maintaining such a list to encourage young doctors to pursue research and ensure that they are mentored by interested researchers and scholars?
I hope that this message will trigger some calm constructive discussions leading to some solutions to encourage research in our region.
Regards,
Sohail Bajammal
Why am I Blogging?
Salam,
I have heard of blogging for years. I have been ignoring it, partly because of being busy with my studies and partly because of the natural of fear of new things.
Although I have a reasonable experience in establishing and running a medical Yahoo group (Saudi Doctors) since 1999 with 600 members currently, I am not quite sure why I have been hesitant to invade the blogging world. Additionally, I have had established a website, which is currently on hold for restructuring and re-design, called MDArabia.com (hence the name of this blog), which deals with health care professionals, institutions and organizations in the Arab World, including a forum, job center, academic calendar, and specialty-based links among other things.
I guess the reason I am having the courage to get into the blogging heat is the interactivity behind it. Additionally, I thought of having all my posts in different forums, groups and mailing lists in one place to guide my thoughts and my future career plan.
For the coming few weeks, I will be posting few posts I submitted over the past few years. We will see how it goes from there.
Regards,
Sohail Bajammal
I have heard of blogging for years. I have been ignoring it, partly because of being busy with my studies and partly because of the natural of fear of new things.
Although I have a reasonable experience in establishing and running a medical Yahoo group (Saudi Doctors) since 1999 with 600 members currently, I am not quite sure why I have been hesitant to invade the blogging world. Additionally, I have had established a website, which is currently on hold for restructuring and re-design, called MDArabia.com (hence the name of this blog), which deals with health care professionals, institutions and organizations in the Arab World, including a forum, job center, academic calendar, and specialty-based links among other things.
I guess the reason I am having the courage to get into the blogging heat is the interactivity behind it. Additionally, I thought of having all my posts in different forums, groups and mailing lists in one place to guide my thoughts and my future career plan.
For the coming few weeks, I will be posting few posts I submitted over the past few years. We will see how it goes from there.
Regards,
Sohail Bajammal
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