My “three E’s” are Efficacy, Effectiveness and Efficiency which were the central theme of a hugely influential monograph: Cochrane, A. L. (1972). Effectiveness and efficiency. Random reflections on health services. Nuffield Provincial Hospitals Trust.
Archie Cochrane (1909-1988) is the Cochrane of the Cochrane collaboration and his book pretty much launched the obsession with the three E’s. So what is Efficacy (as opposed to Effectivenes and Efficiency!)
Details #
As defined by Cochrane efficacy was the evidence that some intervention had some effect as established by a randomised controlled trial so it was evidence that the intervention was statistically significantly (see NHST) better than some alternative. This is actually a very good paradigm for medications which can be given in such a way that neither the clients, the clinicians nor, ideally, the researchers or the data analysts know which arm of the study is which until all the data is collected and all the analyses completed and the study reported completed in all but revealing which intervention was which (strictly that’s a triple blind randomised controlled trial) and where the impact of the itervention is fairly quick and can be measured early during and immediately after the intervention and where that short term outcome really is all we need to know.
You start to see my caveats looming: there are few major challenges even for pharmacological interventions in physical health that fit all those criteria (and I know of literally no triple blind RCT, but then that’s no longer my field). The complexities of modern health care, physical and psychological (forgive the rather Cartesian dichotomy) are rather different but the quest for proven efficacy still dominates much health research as we’re terrified of not knowing, and of being seen not to know.
Ooops. That was a side swipe but real. The monograph hugely impressed and influenced me when I first read it, probably in 1982/3 but I guess as I have moved from hospital, then briefly public health medicine, to psychotherapies and psychosocial interventions I have found the model to almost emperor’s clothes for all that it still is spot on where it is spot on, as above!
Try also #
- Blinding
- Cochrane collaboration/library
- Effectiveness
- Efficiency
- Randomised controlled trials
- Null hypothesis significance testing (NHST) paradigm
Chapters #
The issues are touched on through the OMbook.
Online resources #
None from me likely.
Dates #
First created 1.iv.25, updated links 2.iv.25.
