Guidelines for the management of specified clinical conditions are increasingly being touted as a vital component of the future delivery of health care. However, there are many guidelines that have been drawn up which have remained in the closed shelves of many clinics and hospitals. This article is available only...

Paclitaxel (Taxol®) is a diterpenoid extracted from the bark of a rare, slow growing Pacific yew or Western yew tree (Taxus brevifolia). Its antitumour activity was detected in 1967 in the US NCI (National Cancer Institute) screening of cytotoxic agents from natural products and was then found later to...

Synder in 1932 wrote the first report on the Mendelian inheritance of the inability to taste phenylthiourea. Twenty-five years later, Arno Motulsky suggested hereditary factors might be the explanation to inter-individual differences in drug responses. This article is available only as a PDF. Please click on “Download PDF” on top...

Physicians have long accepted unreliable evaluations of the risks attached to pharmacotherapy, i.e. treating our patients with drugs. The reasons for the uncritical attitude towards medication, which comprise 60% to 90% of all clinical interventions, depending on specialty, have not been systematically studied. This article is available only as a...

Evaluating new drugs for marketing approval is a highly specialised and knowledge-intensive activity. This is especially so if the intention is to conduct quality, safety and clinical evaluations of new drugs that have not been approved elsewhere. This article is available only as a PDF. Please click on “Download PDF”...

Informal review and synthesis of scientific evidence has been practised for as long as experiments have been replicated. The idea of quantitatively combining the evidence from different samples can be traced back to the early 1900s, when Karl Pearson analysed the preventive effect of serum inoculations against enteric fever. This...

There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard” in study design, which enable the question of efficacy of different treatments or managements to be effectively compared. This article is available only as a PDF....

Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is needed to ensure novel, effective therapies continue to be approved for clinical use. This article is available only as a PDF. Please click on “Download PDF”...

Clinical pharmacology (CP) as a discipline comes in many guises. The perception for a medical student, and for many doctors, may be that of a painful series of lists of drugs to learn, the drugs being traditionally classified by functionality and effects. This article is available only as a PDF....

In clinical trials, subjects are usually entered one at a time, and their responses to treatment monitored sequentially. Regular monitoring of trial progress during the early stages is advisable, and prompt attention to data errors, inconsistencies or missing items on the case record forms (CRFs) is required, so that...

The pathway by which patients enter clinical trials can be a selective, non-random process. In order for patients to enter clinical trials, a set of circumstances must occur exclusive of having the disease being investigated and meeting clinical entry criteria. This article is available only as a PDF. Please click...

Traditional designs for clinical trials make balanced (or 50-50) allocation of patients to treatments. This is done in the past to minimise the variance of different estimators. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

There is general consensus that randomised clinical trial (RCT) can provide the most valid conclusions about effects of different treatment as eligible patients are randomly allocated into two or more alternative treatments. Trials using non-randomised comparison groups like historical controls tend to yield more optimistic results than randomised trials. This...

Placebo-trials on HIV-infected pregnant women in developing countries like Thailand and Uganda have provoked recent controversy. Such experiments aim to find a treatment that will cut the rate of vertical transmission more efficiently than existing ‘gold standard’ treatments like zidovudine. This article is available only as a PDF. Please click...

Are medicines dangerous chemicals or life enhancing agents? The answer is ‘Both of those things, often at the same time, and worse in the wrong hands’. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

While clinical medicine is increasingly governed by demands for evidence-based practice and biomedical research increasingly moves towards molecular approaches in the search for new treatments, the public is moving in a different direction—one where science is not the starting point for decision making. This article is available only as a...

There is considerable interest in complementary medicine (CM) and the usage of various alternative therapies is reportedly at an all-time high in the West. Bensoussan stated that each year, 57% of Australians were using CM with an estimated expenditure of A$621 million spent on complementary medicines (products) and A$309...

Past studies on intervention in myopia progression have given conflicting results. For example, in the past, studies on (PMMA) hard contact lenses took researchers in the past on a roller-coaster ride. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The Department of Community, Occupational and Family Medicine (COFM), previously the Department of Social Medicine and Public Health (SMPH), was inaugurated in 1948 as part of the King Edward VII College of Medicine, the forerunner of the National University of Singapore. The Department’s mission is to excel in teaching,...

The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence. This article is available only as a PDF. Please click on “Download PDF” on...

Intra-articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal treatment remains controversial. Kreder et al1 showed that external fixation provides more rapid return to function and superior functional outcome within 2 years compared to open reduction and plate fixation, provided intra-articular step and...

Knowledge and skills of evidence-based medicine (EBM) can be taught by many methods, such as role modeling evidence-based care, using evidence for clinical medicine instruction, and teaching specific EBM skills. Standalone courses and workshops away from the clinical environment are usually the traditional educational designs for teachers to convey...