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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]

#91

Post by sohex »

smegsicle wrote: post #73
msla wrote: post #67

Earlier quoted context omitted.

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?

homeopathic medicine is clearly marked as such, do you disagree on this point? anyone who complains about it who doesn't have at least as strong a crusade against crap like phenylephrine is a hypocrite

That's a weird claim. Phenylephrine has a number of well documented and researched effects with demonstrable efficiency greater than that of a placebo. Now there are certainly people who have and do take it as a decongestant despite that particular usage having been shown to be ineffective, but that doesn't make it crap and it certainly doesn't place it in the same category as homeopathic remedies.

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

#92

Post by theptip »

Gatsky wrote: post #40
jbandela1 wrote: post #15

Evidence Based Medicine is one of those things that is a good thing, but was pushed so hard by its proponents that it ended up overemphasizing a particular kind of study as the only real way to know things in medicine. Yes, absolutely, medicine should be evidence based. Yes, large randomized, double blind, placebo controlled studies provide a lot of information. However, there are limitations with these kinds of stud…

The biggest issue, IMHO, is that clinical trials are often unethical. This is both in theory and especially in practice. I say this as a physician and clinical trial investigator. EBM deals with this by saying ‘there is no viable alternative’, a remarkable statement of epistemological nihilism that enables much low quality snd pointless research.

Can you give an example of unethical trials where “there was no viable alternative” was what got the trial past an IRB? I’m more familiar with inverse complaints that trials are blocked by red tape and hypothetical concerns that are objectively small in actual QALY harm.

(I’m sure this varies by jurisdiction too; I have only heard bad thing about US IRBs)

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

#94

Post by rgbgraph »

sohex wrote: post #89
rgbgraph wrote: post #71

Earlier quoted context omitted.

Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews , vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5 . Page 11. If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5

The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to…

Generally, you read the papers for their methodology and their data — not for the author commentary; and then make up your own mind. One man’s “benefits of statins for primary prevention” is another’s “the benefits are too meager to be notable.”

Please provide me literature from a reputable publication (viz. the AHA, Cochrane, or the New England Journal of Medicine), that has not been funded by a pharmaceutical company — that demonstrates strong supporting evidence for the usage of statins in secondary prevention; wherein the experiment does not extrapolate from LDL values to determine mortality risk (I will concede defeat if you can find any paper that utilizes CAC scans and shows a reversal in atherosclerosis), and/or shows a greater than 2% absolute reduction all-cause or CVD-only mortality risk.

You will not find such a paper, because it does not exist. Most funding has gone towards primary prevention in young adults — while little more than weak associative studies have been published for secondary prevention (and countless others I no doubt have never seen the light of day).

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

#95

Post by justahuman74 »

theptip wrote: post #92
Gatsky wrote: post #40

Earlier quoted context omitted.

The biggest issue, IMHO, is that clinical trials are often unethical. This is both in theory and especially in practice. I say this as a physician and clinical trial investigator. EBM deals with this by saying ‘there is no viable alternative’, a remarkable statement of epistemological nihilism that enables much low quality snd pointless research.

Can you give an example of unethical trials where “there was no viable alternative” was what got the trial past an IRB? I’m more familiar with inverse complaints that trials are blocked by red tape and hypothetical concerns that are objectively small in actual QALY harm. (I’m sure this varies by jurisdiction too; I have only heard bad thing about US IRBs)

I'd have assumed it was when they give sick people the placebo when they have a reasonable hunch (but not a published study that people trust) that the real medication would actually save them

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

#96

Post by andbberger »

lazide wrote: post #74
DoreenMichele wrote: post #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…

All interventions that don’t require a patient being in a coma first requires patient compliance . Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life . Unless the patient comes to you requesting that, good luck. Many will get actively angry if you mention even obvious and severe issues…

treating obesity like a lifestyle condition and not a bonafide disease and dismissing patients with vague recommendations to eat less and exercise more is ignoring the overwhelming body of evidence supporting that behavioral interventions don't work and that the body has strong homeostatic mechanisms which fight efforts to move the weight set point.

i can only hope that you're not a doctor

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

#97

Post by haldujai »

rgbgraph wrote: post #94
sohex wrote: post #89

Earlier quoted context omitted.

The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to…

Generally, you read the papers for their methodology and their data — not for the author commentary; and then make up your own mind. One man’s “benefits of statins for primary prevention” is another’s “the benefits are too meager to be notable.” Please provide me literature from a reputable publication (viz. the AHA, Cochrane, or the New England Journal of Medicine), that has not been funded by a pharmaceutical compa…

So every link I provided give you a risk of MACE. Reversal of atherosclerosis is not the outcome measure we care about lol. Certainly not lowering coronary calcium which is not possible. You’re literally making this up…

Statins work amazingly not just for LDL reduction but plaque stabilization.

As an aside a 2% ARR is huge, it means the number needed to treat is 50 to save a life. For something with next to no serious side effects, rhabdo/diabetes is dramatically overstated.

Pertinently, the number needed to treat for MACE is 39. That’s hugely significant.

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

#98

Post by haldujai »

rgbgraph wrote: post #69
haldujai wrote: post #59

Earlier quoted context omitted.

> 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.

What..? I don’t understand where this is coming from.

Why on earth would we give testosterone to menopausal patients?

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

#99

Post by haldujai »

rgbgraph wrote: post #63
haldujai wrote: post #55

Earlier quoted context omitted.

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 ab…

As stated thennt is from 2013, many statin trials have come out since.

2% diabetes is overstated as in link 1 except you discount it because of declared disclosures despite the fact that it’s one of the most highly cited papers on the subject in the last 10 years and the study was a review.

You also discount a well respected guideline on lipids out of principle.

Then you cite unrelated data from 2006 as a good reference for an unknown reason?

Finally, you disregard the opinions of a Cochrane review in an unrelated patient population which directly contradicts your misinterpretation of the data (clearly have no concept of NNT/NNH as you just make capricious interpretations of ARR) yet cite yourself as more of an expert than the Cochrane authors.

For what it’s worth since you focus on conflicts it’s to my financial benefit if you don’t take your statins (and pharma pays me nothing), so by all means skip the statin at your own risk.

This really doesn’t seem like an open discussion so I’ll stop engaging. But you’re spreading misinformation for any reader, statins save lives.

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

#100

Post by haldujai »

deltaninenine wrote: post #87
haldujai wrote: post #55

Earlier quoted context omitted.

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…

Long term damage to liver. You use it long enough your liver will die. But it's too hard to do a causal analysis on this as the timelines are measured in decades.

I have never heard of or seen statin-induced cirrhosis practicing in a liver transplant center so if this is real it’s a case report.
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