Pour une évaluation des systèmes de santé

Beaucoup de gens sont surpris d'apprendre que l'application de méthodes rigoureuses pour évaluer les médicaments et les pratiques médicales est une pratique récente. Ils seraient tout aussi surpris d'apprendre que la même approche ne s'applique pas encore à la politique de santé.

La médecine basée sur les preuves ou médecine factuelle classe les essais de médicaments en fonction de critères de qualité. Les essais sur les animaux ou les réponses humaines dans le cadre d'un laboratoire sont au bas de l'échelle. Les simples essais comparatifs faisant intervenir des patients qui ont reçu un traitement donné et des sujets contrôle qui ne l'ont pas reçu sont mieux placées, mais peuvent induire en erreur.

Les études les plus convaincantes sont en général les essais randomisés dans lesquels on distribue au hasard le médicament ou un placebo. Les mieux faites comportent des protections supplémentaires contre les biais, notamment les essais en double aveugle dans lesquels ni les patients ni le prescripteur ne sait qui reçoit la molécule active et qui reçoit un placebo.

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