Posted by: sayamika, the killer bunny | 2007 December 14

Evidence-Based Medicine

Code for: we’re not just making it up as we go along, you know.

My favourite thing is always when a person comes into the office with six pages printed off various websites. Or torn out of the newspaper. Or, my recent experience, an episode number from 60 Minutes or some such.

Have you heard about this? It was in the news last week. 

Yes, I have. The research around it is at least six years old by the time it hits the news. We’ve already done Grand Rounds on it. It’s standard practise/it’s been discredited/it’s not applicable to your case.

  • Stool enemas for recalcitrant C. difficile? OK, that’s gross. And a last resort if you are quite perturbed about being a chronic carrier, but not for clinically active C. diff. We’re not there yet.
  • Zolpidem for coma? Yes, I’ve seen Awakenings, too. Great film. I cried buckets. Let me check out the safety data and discuss it with the neurologist and your neurosurgeon, and we’ll give it a go if it looks reasonable. But PLEASE don’t hang your heart on this.
  • Avandia is killing you? OK. We’ll try something else. But the data are pretty shaky, and your ankles were swollen BEFORE you were taking it and they really don’t look any worse.
  • You read in the paper that your BP meds don’t go well together. Hm. Are you having any of the problems they list in your article? How’s your BP? You do realise that this is one physician’s opinion based on some incomplete studies. Sure, if you’re still worried we’ll switch them up, but you may experience side-effects you did not have in the past from the new meds.

I think it’s important to take an interest in your own health and to be your own advocate. I think it’s even more important to look critically at your source of information. As a general rule, if there are page three girls and advertising revenue involved, the advice might not be the soundest. But that’s just my opinion.

It’s a bit like the MMR vaccine/autism debate particularly in the UK. A single small study, in a hypothesis-generating format and extrapolated to enormously important conclusions as proof. The study has now been disowned by all authors except the one making pots of money from speaking engagements on the subject.

As a study looking for a reason to do further studies, it was enormously successful, and certainly appropriate.

Now the further studies have been done, and they show quite clearly that there is no link between MMR or thimerosal/mercury of vaccine source and neurodevelopmental scores. Where’s the media coverage now?


That’s what I thought.


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