Comment Evidence-based medicine in China In recent decades, evidence-based medicine has been Medical associations in every discipline have built propagated rapidly in China, not only to doctors but clinical guidelines for common diseases according to to nurses and other health-care professionals. the evidence to inform clinical decision making and Chinese Journal of Evidence-Based Medicine, the teaching. Evidence-based medicine has also engaged Journal of Evidence-Based Medicine, and the Chinese with traditional Chinese medicine. Research teams in Journal of Evidence-Based Pediatrics were launched in traditional Chinese medicine have been established and 2001-06. Several organisations developed programmes the rigour of traditional medicine has been gradually to strengthen a national culture of evidence-based raised. The Chinese clinical trial registry was established medicine, including the clinical epidemiology committee in 2007 and the number of clinical trials registered in of the Chinese Medical Association(established in 1993) China is increasing(figure) working with the Chinese Clinical Epidemiology Network There are, however, several concerns about the devel (ChinaCLEN; registered as part of the International opment of evidence- based medicine in China. First, Clinical Epidemiology Network in 1989),the Chinese access to scientific evidence is not equal in all regions Cochrane Centre(which became the 14th centre of Doctors from developed areas and large cities, such as the International Cochrane Collaboration in 1999), Shanghai and Beijing, can search the literature for free the Ministry of Educations virtual research centre of at their university via databases such as Medline. But evidence-based medicine founded in 2004, and the doctors in remote areas might not be able to access China Medical Doctor Association,'s evidence-based the best information resources, which, together with a medicine committee organised in 2003.3 limited knowledge of English, could prevent use of the The board members of these organisations are located best evidence in their practice seminate Second most of the world 's clinical evidence does knowledge of evidence-based medicine throughout the not come from China. Few results from China have country Programmes(usually 1-3 months)organised been included in systematic reviews or clinical by the Ministry of Education, continuing education practice guidelines. I calculated that from 1999 to programmes, and online education programmes are 2008, 1880 clinical research articles were published available. Clinical epidemiology and evidence-based in The New England Journal of Medicine, The Lancet, medicine have become compulsory curricula for medical and JAMA. However, only 0-21% of these were from students and clinical postgraduates in all universities. mainland China. Wu and colleagues analysed randomised trials on 20 common diseases published in Chinas natural knowledge infrastructure database from 1994 to 2005, and found that only 7% of them met methodological criteria(according to Cochrane review criteria). Frequent errors in statistical analyses are also found in Chinese medical journals, which reduces the credibility of the evidence Third, because of a lack of funding for investigator-led trials are pharmaceutical premarketing trials sponsored by drug companies. Such research is more likely to have could result in publication bias. Finally, although the Chinese government has made research into traditional 2006 0072008 medicine a priority area and randomised trials have shown effcacy for some nal therapies, because We searched clinical Trials. go on June 15, 2009, with the term "lead principal investigator/sponsor=China ity of trials and selective 第10页 www.thelancet.comVol375February13,2010Comment 532 www.thelancet.com Vol 375 February 13, 2010 Evidence-based medicine in China In recent decades, evidence-based medicine has been propagated rapidly in China, not only to doctors but also to nurses and other health-care professionals. The Chinese Journal of Evidence-Based Medicine, the Journal of Evidence-Based Medicine, and the Chinese Journal of Evidence-Based Pediatrics were launched in 2001–06. Several organisations developed programmes to strengthen a national culture of evidence-based medicine, including the clinical epidemiology committee of the Chinese Medical Association (established in 1993) working with the Chinese Clinical Epidemiology Network (ChinaCLEN; registered as part of the International Clinical Epidemiology Network in 1989),1 the Chinese Cochrane Centre (which became the 14th centre of the International Cochrane Collaboration in 1999),2 the Ministry of Education’s virtual research centre of evidence-based medicine founded in 2004, and the China Medical Doctor Association’s evidence-based medicine committee organised in 2003.3 The board members of these organisations are located all around China, and have sought to disseminate knowledge of evidence-based medicine throughout the country. Programmes (usually 1–3 months) organised by the Ministry of Education, continuing education programmes, and online education programmes are available. Clinical epidemiology and evidence-based medicine have become compulsory curricula for medical students and clinical postgraduates in all universities. Medical associations in every discipline have built clinical guidelines for common diseases according to the evidence to inform clinical decision making and teaching. Evidence-based medicine has also engaged with traditional Chinese medicine. Research teams in traditional Chinese medicine have been established and the rigour of traditional medicine has been gradually raised. The Chinese clinical trial registry4 was established in 2007 and the number of clinical trials registered in China is increasing (fi gure).5 There are, however, several concerns about the devel￾op ment of evidence-based medicine in China. First, access to scientifi c evidence is not equal in all regions. Doctors from developed areas and large cities, such as Shanghai and Beijing, can search the literature for free at their university via databases such as Medline. But doctors in remote areas might not be able to access the best information resources, which, together with a limited knowledge of English, could prevent use of the best evidence in their practice. Second, most of the world’s clinical evidence does not come from China. Few results from China have been included in systematic reviews6 or clinical practice guidelines. I calculated that from 1999 to 2008, 1880 clinical research articles were published in The New England Journal of Medicine, The Lancet, and JAMA. However, only 0·21% of these were from mainland China.7 Wu and colleagues8 analysed randomised trials on 20 common diseases published in China’s natural knowledge infrastructure database from 1994 to 2005, and found that only 7% of them met methodological criteria (according to Cochrane review criteria). Frequent errors in statistical analyses are also found in Chinese medical journals,9 which reduces the credibility of the evidence. Third, because of a lack of funding for investigator-led randomised trials, most good-quality Chinese clinical trials are pharmaceutical premarketing trials sponsored by drug companies. Such research is more likely to have outcomes that favour the sponsor’s product, which could result in publication bias.10 Finally, although the Chinese Government has made research into traditional medicine a priority area and randomised trials have shown effi cacy for some traditional therapies, because of the low methodological quality of trials and selective 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year 50 100 150 200 250 Numbers 300 350 400 450 500 Phase 1/2 Phase 3 Phase 4 Randomised trials Observational studies Total Figure: Growth in clinical trials in China We searched ClinicalTrials.gov5 on June 15, 2009, with the term “lead principal investigator/sponsor=China”. 第 10 页