The Non-Science of Medicine
July 27, 2017 1:37 PM   Subscribe

When evidence says no but doctors say yes. "For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments... it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. ...Chances are, you or someone in your family has taken medication or undergone a procedure that is bio-plausible but does not work."

"In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade — 2001 through 2010 — that tested a current clinical practice, from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections). Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced."

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"In the late 1980s, with evidence already mounting that forcing open blood vessels was less effective and more dangerous than noninvasive treatments, cardiologist Eric Topol coined the term, “oculostenotic reflex.” Oculo, from the Latin for “eye,” and stenotic, from the Greek for “narrow,” as in a narrowed artery. The meaning: If you see a blockage, you’ll reflexively fix a blockage. Topol described “what appears to be an irresistible temptation among some invasive cardiologists” to place a stent any time they see a narrowed artery, evidence from thousands of patients in randomized trials be damned. Stenting is what scientists call “bio-plausible” — intuition suggests it should work. It’s just that the human body is a little more Book of Job and a little less household plumbing: Humans didn’t invent it, it’s really complicated, and people often have remarkably little insight into cause and effect."

Two important concepts: NNT and NNH.

Cited in the article the website theNNT.com(previously), gives quick summaries of evidence-based medicine. For instance, the terrible numbers behind statins.
posted by storybored (3 comments total)

This post was deleted for the following reason: Aw, shoot, looks like we saw this a few months back. -- cortex



 
In order for doctor's to practice full-time evidenced based medicine you'll first need to locate a population willing to participate. Good luck telling 98% of patients (or more likely their spouse or family) in the ED with angina, stable or otherwise, that they don't need a cath. It doesn't excuse the absence of a full PAR (procedure/alternatives/risks) discussion, but most people hate the EBM approach because it usually requires more effort on their part (lifestyle changes) patience (wait 6 months for sciatica to improve v. a MRI and neurosurgical consult) and their ability to understand and grasp the myriad ways things can go to shit slowly or all at once as soon as doctors start mucking around is extremely limited. For many people doctors and surgery and procedures and medications are SO routine that they don't blink. In the first example a highly motivated and curious executive avoided a cath. That is pretty far from the norm as far as medicine goes. Take any day in the average urgent care and listen to the gymnastics required to keep a patient away from antibiotics for viral bronchitis or an MRI for simple low back pain. This has to be a 2 way street, and so far most doctors aren't doing a great job. If we nationalize medicine and pay doctors for health outcomes instead of volume EBM will be acheivable quite rapidly.
posted by docpops at 2:01 PM on July 27 [1 favorite]


Since you call out statins, there is a really important caveat to the link you provided.

While statins without prior heart disease are bad, as the NNT shows, statins for people with prior heart disease are lifesavers with an NNT of 83 for mortality.

This is a big enough thing that it may be worth modifying the FPP to make your link clear.
posted by blahblahblah at 2:01 PM on July 27 [1 favorite]


If we nationalize medicine and pay doctors for health outcomes instead of volume EBM will be acheivable quite rapidly.

As a Canadian, it's worth noting that the one doesn't necessarily follow from the other. But maybe that's obvious...
posted by klanawa at 2:08 PM on July 27 [1 favorite]


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