Category: Clinical Trials

Evidence Based Medicine & The Art of Flipping Coins

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It’s become a major problem in our quest to obtain a perfect healthcare system.

It’s called science.

Now, don’t get me wrong. I have nothing against observation and experimentation. But, since blind pursuit of anything can lead to destruction, it’s time to take more notice.

To be fair, it’s not science, per se, we are talking about. It’s our interpretation of it—how we perceive its role to be within the framework of medicine.

I’ll begin with a simple illustration.

I will flip a coin 10 times. I will tabulate the number of instances the coin returns heads or tails. Then, I will repeat the experiment 10 more times.

In fact, here are the results:

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How Arbitrary Feels

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We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because the medical world is now full of panels. And, paradoxically, it seems more confusing and arbitrary than ever before.

Recently, I’ve taken some interest in economics. I thought I understood it before. That was when I didn’t understand it at all. I used to believe the goal was to create jobs, since jobs obviously drive the economy. I was almost on the right track. Until I realized I wasn’t tracking at all.

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The Bullfight For Evidence

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It’s been a chatterbox kind-of-week for evidence-based medicine.

First, an article appeared in the New England Journal discussing its limitations. Then, a rebuttal came from an established bull in the China shop, and we were well on our way. Ultimately, all sides made a point.

Seemingly bored by the chatter, however, may have been Medical Progress herself. She has and will continue to move forward on her own terms—sometimes with and sometimes without randomized controlled trials.

There are not many novel ideas to discuss here. Evidence frequently has claimed to be guiding medicine. Sometimes it has originated from the experience of a single person or two. Sometimes pseudo-clarity has required the trials of ten-thousand. Only very recently has evidence even existed for some in hierarchical structure—”hard” or “soft” these people now say.

But, what does “hard” or “soft” evidence really mean anyway? And, who gets to define these terms?

The policy makers?

The New England Journal?

The bull? The baker? The candlestick maker?

Almost contrary to what the gnostics of evidence proclaim to be best, the majority of individual medical decisions are made using so-called “soft” evidence. And, no, this isn’t some atrocity.

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A Friend? Must You Have…

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My wife and I had planned a three day trip to celebrate our anniversary. 

Extended family was in town to watch our boys over the long weekend while we were going to be away. And, yes, it’s always challenging getting out the door.

I’m not talking about the often bizarre scenarios that befall my private-practice patients in the hours leading up to any scheduled vacation. I’m really just talking about parenting.

If you’ve been there… you know. You just know.

The school lunch supplies must be lined out and ready to go. Clothes have to be washed. Instructions for this and that must be given for the extended family. I really thought I stressed about these things far less than other parents, until I saw my kitchen completely covered with post’em notes.

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Cancerous Beliefs On Screening

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Cancer screening has NEVER been shown to save lives.

That’s the eye-catching title of a recent article emanating from Academic medicine.

I liked it.

I’ve known for some time that we bother too many patients with absolutely no symptoms of disease under the guise of Evidence Based Medicine (EBM). So, of course, I started reading it.

The lead author has been involved with other discombobulating publications of statistical mumbo-jumbo. So, naturally, I wondered what sensible and non-sensible use of statistics I’d encounter.

It didn’t take long for me to find both.

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“No WATCHMAN™ For You!”

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Healthcare insurance deductibles have increased seven times faster than wages in the last five years.

In case you missed the memo already sent to your pocket book, our system is not designed to help anyone afford quality care.

Few understand it. How it works. Who controls it.

Most of us just accept it.

Maybe, it’s because we’ve led ourselves to believe a world cannot exist without having a Food and Drug Administration (FDA) to protect it. America’s unregulated $37 billion vitamin and supplement industry may speak to the contrary, but yes, we seem to sleep more soundly believing there is a watchdog on our front porch.

It would be ideological suicide to question what’s really there.

And, so we believe. Me included.

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If You See A Study Labeled “Landmark,” Throw It In The Trash

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I’m going to tell you the real goal for a clinical trial in medicine these days.

It’s to be landmark.

It’s what the trial sponsors seek and their investigators envy.

Landmark is the ultimate goal.

In fact, trial sponsors will frequently call their own study landmark even before it gets published in a scientific journal. Kind of like getting your Super Bowl ring fitted during the preseason.

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