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The Rise and Fall of Evidence Based Medicine (1998) [pdf]

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Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#61
post #56

Earlier quoted context omitted.

There are multiple different statins. The latest research indicates that some are more effective than you indicate, with a lower rate of serious side effects. https://peterattiamd.com/johnkastelein/

I had an inkling I should have ended one of the points with that line of thought. However, I haven't seen any research that shows more than minor absolute risk changes, regardless of statin -- they're the wrong drugs for the job.

Do you have a single citation to back this claim up? Unless you’re talking about prophylactic statins in patients with no known risk factors (I.e. primary prevention which is not standard of care) this is complete misinformation.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#62
Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases.

Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home.

Star Trek's Dr. McCoy and his tricorder was a dream of tech that you could carry in the proverbial little black bag. We aren't there and have forgotten a lot of important principles in the process of pursuing shiny tech.

But it's generally a bad idea to critique any of that. Gets one nothing but hatred.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#63

Earlier quoted context omitted.

In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best ( - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic - Generic lipid panels that the vast majority of people take are generally worthless for esti…

What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best ( It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting…

All adult patient populations: those without a history of cardiovascular events, and those with.

Baseline risk is something like ~35% for men, and ~20% women. Time point is from 50 to 75 years of age.

Statins -- at most -- reduce your absolute risk from 35% to 33% (for men) and from 20% to 18% (for women).

If you do not smoke, your absolute risk drops by ~7%, from 35% to 28%. If you're diabetic, your risk jumps an absolute ~30% to 65%.

See: https://www.ahajournals.org/doi/full/10.1161/circulationaha.... (table 2 & table 3).

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Your article has this caveat: "Virtually all of the major statin studies were paid for and conducted by their respective pharmaceutical company. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that these results are often much more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results."

Ignoring that, 2% (absolute) of the population on statins develop diabetes and 10% (absolute) develop muscle pain/rhabdo (in one experiment). This is also ignoring all of the serious adverse events from gen-1 and gen-2 statins.

As a whole, they on average achieve a 1.2% reduction in absolute mortality (all-cause or only from heart disease?).

While I have just read it, I'm going to discount [1], because of what's inside "Declaration of interests."

And on principle, I'm not going to read [2], unless you quote the relevant sections (as is good form when referencing).

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#64

Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star…

I think this is a pretty thoughtless statement.

Ashkenazi women often have genetic mutations that cause them to get breast cancer and the cancer prognosis is much worse than average. This cannot be addressed by diet or lifestyle. However, genomic sequencing detected common patterns that can be tested for, and with that information, women can make informed choices about treatment or other actions, ideally well before they ever have a malignant tumor.

I won't disagree that we could do a lot better overall with large-scale changes in diet and lifestyle. But it still would leave a lot of people dying of heart disease and cancer as well as infectious diseases.

Those x-ray machines and MRI machines make a huge difference for people with internal injuries as well. No amount of diet and lifestyle will heal a shattered bone.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#65

I'd love the idea of science based medicine. There are a few issues: >HIPPA has made it basically impossible to do science in Medicine without being part of the establishment >The medical cartels hate change, its bad for business, they actively lobby against change and competition. They want authority based medicine. >The scientist responsible for the discovery and treatment of an issue, can't even legally practice.…

HIPAA (not HIPPA) actually makes data more portable, not less. It also only applies to a subsection of the medical research industry. A great deal of discoveries don't involve HIPAA-covered data at all.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#66

Earlier quoted context omitted.

What exactly is HIPAA’s role here? With or without HIPAA, medical institutions don’t want to share their data, especially not the ones with good data because they do their own research.

not op: but possibly ... The free exchange of information would make publicly funded data-driven discoveries more feasible. (?)

Yes, this is almost certainly true. However, so far we've underutilized the data, for a number of mostly social/incentivization reasons, rather than scientific ones.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#67
post #13

Earlier quoted context omitted.

> they can just make it "evidence based homeopathic medicine" and so on and so on Only if the homeopaths lie about the evidence.

curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness

Yes, it's 'curious' how people with a sense of basic decency get 'combative' when the Alternative Medicine Industry lies to them to sell useless treatments for diseases that could actually be improved by real medicine. It really is odd how that works, isn't it?

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#68
post #32
post #14

Earlier quoted context omitted.

but if you got better, how would you know it was the doctor and not just random chance? base rate fallacy applies

In my case, I've been suffering from disc herniation induced sciatica for 5 months When I say suffering, I mean it - I haven't been able to stand, sit, lie down, walk, do anything without constant and extreme pain. For months on end now. There is a gold standard study called SPORT that proves more or less beyond all doubt that, in the long run, there is no difference in outcomes for patients who get disc herniations…

To add to that studies findings: in general, many people who have back surgery end up worse-off than before, because back surgery is risky.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#69

Earlier quoted context omitted.

I do agree things should be studied but you have to be careful with it. Studies are big and expensive and things can be missed. Remember the big flap over hormone replacement therapy being shown harmful? Oops--all it really showed is what we knew all along, estrogen is risky for fat women.

> estrogen is risky for fat women I think what you meant to say is unopposed estrogen is risky for all women.

It's a shame I have yet to see a microdose of testosterone included in HRT.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#70
post #8

Earlier quoted context omitted.

homeopathic medicine, chiropractic medicine, folk medicine, traditional medicine, osteopathic medicine, crystal healing medicine... you can make an infinite list of nonsense and if you want to disambiguate and say "evidence based medicine" to refer to actual medicine, they can just make it "evidence based homeopathic medicine" and so on and so on can't beat these people

when Western doctors visited China under Nixon, the great medical practices of Chinese medicine were on full view .. acupuncture, herbs, other parts.. The Western Doctors uniformly mocked the Chinese upon return.. oddly reminiscent of the Chinese mocking the "stone age" Tibetans at a later date. zero medicine anywhere but in your own guild, it seems

https://slate.com/technology/2013/10/traditional-chinese-med...

"Traditional Chinese Medicine" as we now know it was invented as a propaganda move by the CCP under Mao, who didn't believe in it himself.

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