The Cochrane Collaboration published two new papers last month that might be of interest. Or they might not of course because the CochCollab publishes reviews of evidence-based practice in healthcare, and they have such a limited view of evidence that most of what they publish has very little point. Hence these two: one is on whether end-of-life care pathways (like the Liverpool Care Pathway, which the Department of Health recommends) have generated any evidence to say it’s of any use. Similarly music therapy in palliative care. The answer in both cases is ‘no’.

What are we doing all this for then? you ask. Generalised organisational practices such as integratied care pathways involve so many factors that it’s hard to imagine any random controlled trials telling you anything useful about them. And music therapy or music activities are such a disparate range of activities that it’s hard to imagine…similarly. And again, since they are mainly concerned with whether these things have any effect on symptoms, physical or psychological, or vague concepts such as quality of life or potential harms they’re hardly likely to come up with any results.

Lets be clear; there are some aspects of healthcare, such a physical treatments, that have measurable effects on human beings that you can calibrate and you neeed to do it for safety and effectiveness. There are other aspects of healthcare that are about how you organise a fairly complicated service or some aspects of the care environment that might make people more comfortable and happy. These cannot and should not be measured in the same sort of way; their objectives are different. Whisper it gently, they are often about achieving such social objectives as a speedy, thoughtful and congenial response to people’s feelings about what’s happening to them.

This sort of pointless activity brings the whole research enterprise into disrepute. Healthcare research is just not asking the right questions about the appropriate care environments that give people dignity and a caring experience.

But if you must read these things:

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008006/frame.html  (end-of-life care pathways).

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007169/frame.html (music therapy).