Evidence based medicine/health- Part 1

There is a Lot of  Science + Much of It May Not Be Reliable
Reading” a Clinical Trial Won’t Get You There
(Posted on April 27, 2015 by es)

http://delfini.org/blog/?p=723

There is a Lot of  Science + Much of It May Not Be Reliable

Each week more than 13,000 references are added to the world’s largest library—the National Library of Medicine (NLM). Unfortunately, many of these studies are seriously flawed. One large review of 60,352 studies reported that only 7 percent passed criteria of high quality methods and clinical relevancy [McKibbon]. We and others have estimated that up to (and maybe more than) 90% of the published medical information that health care professionals rely on is flawed [Freedman, Glasziou].

 We cannot know if an intervention is likely to be effective and safe without critically appraising the evidence for validity and clinical usefulness.

Failures to Understand Medical Science Basic

Many health care professionals don’t know how to quickly assess a trial for reliability and clinical usefulness.

 1. Comparison group
Without a comparison group of people with similar prognostic characteristics who are treated exactly the same except for the intervention under study, you cannot discern cause and effect of an intervention because a difference between groups may explain or affect the results.

 2.Presenting  results as relative risk reduction (RRR) without absolute risk reduction (ARR)
A “relative” measure raises the question, “Relative to what?” Is the reported RRR in our test question 60 percent of 100 percent? Or 60 percent of 1 percent?

 3.Missing data 
The two requirements are that people should be randomized as analyzed and that all people should be included in the analysis whether they have discontinued, are missing or have crossed over to other treatment arms.'

 

My own  observations 
 Bias in interpreting the data depending on the educational background and experience

1. Educational background
-Conventional  medicine vs hollistic
- Univeristy bias- some are more focus on prevention and minimal intervention approach 
-Country of graduation intertwined with the legality of the sytem
-Year  of Graduation as practice of medicine has changed due to the finacial incentives
-Funding of the educational institution- state, private or independent ( where  searching for  scientific truth is more important than financial profit)

2. Experience of  the practitioner
- empirical data  gained only through clinical application -what works and does not work
- the importance of case selection 
-sources of literature used as part of further education
-the legal system  in which the health practioner is practicing

There is a need  for transformation in research  and it's relevance to clinical  practice  .
There needs to be a shift from dogmatic practice from  it's universal simplistic approach ( a pill for every ill)  to an integration of health sciences and  an awarness in the human limitations in understanding the complexity of biology.

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