THE WORTHLESSNESS OF MOST MEDICAL STUDIES

As a medical physician for over 50 years, I strive to give you the best medical information on controversial medical subjects and let you, the reader, come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary that results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Let me know how we are doing. Your constructive comments are always appreciated. Click the RSS post button on the upper right hand corner if you would like to receive by email our future medical blogs.
Visit http://www.americanacupuncture.com/ for more detailed information on healing.

MOST CLINICAL MEDICAL TRIAL  ARE  WORTHLESS

Can you believe the results of clinical medical trials?  The government and the AMA say over half of them have little merit.  (This is a nice way to say they are worthless.)

The media bombards you with short abstracts about various research studies.  Big Pharma,  fills the TV channels about which drugs may be good for you and help your various ailments.  Don’t believe everything you hear. 

Good medical practice needs more than knowledge.  Experience and clinical judgment is needed to know when the evidence does not apply to you or if the evidence is shallow.  Soon, there will be no individuality in your health care.

You know that when data and studies look good, logic tell you to accept the scientific facts.  But what if there are no studies on the data, or the clinical trials are poor?

A study is only as good as the methods used, and that there is uniformity in the patients studied.  Since all of us are complex humans, living and functioning in complex environments, it is hard for any study of patients to be uniform and often this compromises the study.

ANALYZING A SCIENTIFIC ARTICLE

You must first ask:  Is this information from a scientific journal?  Do you  have a systematic way to retrieve your needed information?  Judge by yourself, if the scientific evidence is flawed, and what is the main point of the published article?  Decide what are negative and positive aspects of the article.  Can you use and interpret the scientific article to draw your own conclusions?  Do you have any ethical concerns about the clinical study in the article?  Is the statistical analysis appropriate?   Can you analyze and synthesize the information to explain or argue a point?

A given hypothesis can be confirmed or rejected, if a study is valid well designed, with a perfectly homogenous patient population.  But can you extrapolate the findings to individual clinical situations if the conclusions are not valid for a heterogeneous population?   Few studies include patients over 60.  These studies are then extrapolated to the elderly who react totally different to the younger population.

A study will conclude that there is a 50% reduction, for example in blood clots with the use of Crestor statin.  Suppose there are only 2 clots per thousand, and taking the drug reduces the incidence to 1 clot per thousand.  Your risk in not taking the drug becomes, not 50%, but one out of 500, or 0.2% chance of a blood clot.  What percentage of side effects will be present in all 1000 of the drug users?

RECENT CLINICAL HEART STUDIES QUESTIONED BY AMA

High quality scientific testing supports only 11% of all the recommendations by cardiologists for treating heart patients.  Over half of them are worthless (limited is the word the AMA uses).  

These studies include taking aspirin after a heart attack to prevent another one, and taking blood thinners for a year after getting a stent. These treatment decisions are often dogmatic, even if evidence is very weak for these treatments.

Many of these studies were designed to win approval for treatments or widen the market for a therapy that is currently used and not to guide treatment decisions.  Often the experts picked are getting consulting money from the drug industry, creating a conflict of interest, and bias undermines their credibility.  The results of all these, according to the study, are based simply on experts viewpoints and not supported by rigorous scientific studies.

GOVERNMENT PUSH

The Obama administration is seeking the best care possible for the least cost.  The government is trying to reduce the wide variation in medical care and make it more standard (cook book).  They are attempting to set standard to measure your doctors and hospital performance, to help them make the changes in health care and reduce costs.  The government is busy questioning the effectiveness of medical guidelines over the last 20 years.  Mounting evidence supports using C- reactive protein markers and scans for calcium buildups in your arteries, yet studies show very little solid evidence.

YOUR DOCTOR HAS A PROBLEM

This leaves doctors in limbo as to the best course of treatments of many conditions.   Your doctor now is not sure about the best thing to do in the hospital operating room or in his office; the legal malpractice lawyers will now have a field day.

The medical profession must know the current state of medical literature, but all these published studies should not bind your doctor and prevent him from alternative pathways.  They are only guidelines for him to aid him to focus on his clinical decision of your treatment.

Medical reading is not enough.  Touching and listening by your doctor is just as important.  Take with a grain of salt all of the medical tidbits you get on a potpourri of subjects.  Rely on the judgment of your doctor when trying to solve your medical dilemmas. 

With national health care on the horizon, it will not be long that you will be forced to a standard treatment that will not work for you, but  at least will be cost saving for national health care.

Your comments are always appreciated.  Visit www.drneedles.com for more information on clinical controversial subjects.

Source: JAMA Feb 25, 2009, Tricoci