In the following, quotations
from 16 own publictions on research problems are cited:
"Unity makes strong, but too
much unity also makes stupid." [Translated from German]
Schou J. Richtlinien - für die Erstellung und Einhaltung von Richtlinien in der Notfallmedizin. Notfallmedizin 1992;18:10-11
" ... in the absense of
standardized patients, distinguishes the fine spectrum of clinical pictures
in emergency medicine."
Schou J. Guidelines for the use of guidelines (editorial). Prehosp Disaster Med 1993;8:19-20.
"While challenging the
possibilities for making controlled studies in prehospital emergency medicine
(...), I believe there is a lot to learn from simple descriptive studies.
... editors should be encouraged to publish such studies ..."
Schou J. Update on prehospital care. Curr Opinion Anaesth 1994;7:191-8.
"Clinical research should
not be restricted to standardized and spiritless mathematical efforts but
have its origin in clinical observations, nourished by ... philosophical
measures."
Schou J. The double-blind anaesthetist, in: A Philosophical Approach to Anaesthesia (ISBN 3-928811-05-3), Alix Publ. Group 104 pp, 1994.
"Unfortunately, on both
sides of the Ocean, the total number of missions is usually used as a measure
of success."
Schou J. Maximum vs. optimum in prehospital emergency care - a call for compromise (editorial). JEUR 1995;8:125-6.
"... prehospital research
differs considerably from in-hospital research. This difference must be
emphasized since the absense of strictly controlled prospective studies
may be misinterpreted as a lack of scientific soundness."
Schou J. Improvement of prehospital trauma care: the single case and the randomized study (editorial). Eur J Emerg Med 1996;3:219-20.
"Is it possible to propose
a ban on prehospital randomized studies without suggesting other methods
of scientific approach? For comparison, ... it must be possible to claim
that an apple is rotten without offering a new fruit."
Schou J. Ban prehospital randomized studies. Eur J Emerg Med 1997;4:174-5.
"What have RCTs added
to medicine and how are their findings interpreted? These studies seem
to add stupidity rather than intelligence to medicine. This was not the
intention of their authors but their (mostly negative) conclusions are
cited far beyond the limitations of their studies."
Camporesi E, Schou J. Are randomized studies necessary in prehosital emergency medicine? Pro-&-Con. TraumaCare 1997;7:69-70.
"The prospective ... (RCT)
has been called the 'gold standard' of research. For this reason, many
physicians feel that this kind of research should be made universal and
that it simply must be possible to design an RCT anywhere. This is where
I, as a potential patient, demand protection against such researchers."
Schou J. Prehospital research and clinical decision-making. Eur J Emerg Med 1998;5:74.
"... the introduction
of a quality control system may be a useful method for putting the staff
... under pressure."
Schou J. Research in PHEM, in: Prehospital Emergency Medicine - Challenges and Options in Rescue Services, 2nd Edition. Harwood Academic Publ., Amsterdam B.V. ISBN 90-5702-003-3, 448 pp, 1997.
"It is evident that if
a method is used wrongly, a study of it is likely to show that it does
not improve therapy and may even show a worse outcome. ...... recognition
that current research has led to wrong conclusions and stagnation in the
field of prehospital emergency medicine. Is it now the time for a change?"
Schou J. Scientific Misconduct in Resuscitation and Emergency Medicine - Time for a Change? Proc., 4th Europ. Resuscitation Council 1998;177-80.
"An RCT is expensive,
labourous and troublesome. Therefore it is unlikely to be carried out unless
a "positive" result is expected. This precondition may make participating
doctors biased and raises the question if both study arms (before the results
are known) can really assume equality of therapy, as demanded by the declaration
of Helsinki."
Schou J. In the shadows of guideline medicine. Intenssive Care World 1999;14:190-1.
"It is quite possible
that such awareness during anaesthesia occurs all the time, or at least
very often, without necessarily causing harm to the patients. How can you
prevent something which occurs very often, do you need to prevent it, and
are other measures necessary?"
Schou J. Awareness in anaesthesia. Lancet 2000;355:1723."I doubt that much can be achieved within medical circles. Maybe clearcut restrictions to ethically doubtful research will be found only when adressing the lay victims of improper RCTs."
"Testing the hypothesis of „no difference,“ the majority of these studies do indeed find the tested substance favourable, often the way to get a drug licenced for an indication and thus an additional ethical question is raised by the study, if namely the difference was really so unexpected that a placebo-group could be included. ............ To a certain degree practice influences contemporary ethics. There is also a danger of getting used to what others are doing."
Schou: Medical Research and its Victims BMJ Electronic Letters
Schou J. The Declaration of Helsinki and emergency medicine research (editorial). Eur J Emerg Med 2001;8:167-8.
A Conflict to Come
In getting accustomed to unethical
behaviour, physicians are losing the right to decide about the ethics of
medical science