Prof. Rod Baber
Biography:
Rod Baber is Clinical Professor of Obstetrics and Gynaecology at The University of Sydney.
He is a Past President of The International Menopause Society and The Australasian Menopause Society and former Editor in Chief of Climacteric, the journal of The International Menopause Society. His awards include membership of The Order of Australia for services to Obstetrics and Gynaecology in clinical medicine and research, The IMS Lifetime Achievement Award and The RANZCOG Distinguished Service medal.
Abstract:
The word ‘epidemiology’ was known to the Ancient Greeks who considered it the study of epidemics.
As epidemics became less frequent, and epidemiologists more common, the word came to stand for much more and today it may be defined as the study of diseases and the benefits or otherwise of treatments to improve public health, prevent disease and improve quality of life.
Early attempts in this area simply calculated rates of disease and rates of response to treatment but, in the last 60-70 years the word ‘rate’ has largely been replaced by ‘risk’ and the idea of clinical practice based on an apprenticeship system of experience and learning has been replaced by advice based on population-based risk probabilities, ideally derived from randomized clinical trials (RCTs).
In 1970, 355 RCTs were published in medical journals, in 2000 that number had risen to 11,000 and by 2020 to 30,000 RCTs per annum.
The development of guidelines and recommendations followed, and clinical medicine came to be based on new parameters and terms including evidence-based medicine (EBM), number needed to treat (NNT), probability, absolute risk, relative risk, odds ratio and hazard ratio.
Public health and clinical medicine split, and many clinicians and patients were left behind, confused by data and descriptions of risk (or benefit) of which they had little understanding let alone the tools to allow them to explain the results of this year’s 30,000 RCTs to their patients.
This paper will attempt to define the terms commonly used in clinical trials and suggest methods of understanding and explaining risk.