Evidence Based Medicine
And why it took us so long to get there.

Medicine, like so many other fields, used to do things in a certain way just because they'd always been done in that way. Take broken ribs. The conventional treatment used to be to strap up broken ribs in a tight bandage around the chest. This achieved the square-root of fuck-all except to make the patient even more uncomfortable. It wasn't until some curious doctor started to measure patient outcomes that they discovered the ribs would heal at exactly the same rate regardless of whether they were strapped up or not.

Then take the duodenal ulcer. Used to be amongst the most common causes of surgery. Sometimes the surgery worked, often it didn't - and the doctors didn't know why. It wasn't until two bright sparks in Australia realised that almost all patients with the condition were infected with a common bacteria - H. pylori - and a simple regime of antibiotics were enough to clear up the ulcer in most cases. This was also the reason that some patients who had other surgery got better. It wasn't the surgery - it was the antibiotics they were given during the surgery that cured them.

So, it's puzzled me for ages why medicine didn't adopt evidence based medicine earlier. For a lot of conditions doctors used to be no more than modern witch doctors. Shake this stick, drink this tea, don't drink that coffee - with absolutely no clue as to what cured some of the patients. Was it shaking the stick or drinking the tea?

It's a lot better now but we're still not there. Some doctors still prescribe based on what they've always prescribed regardless of any evidence that the remedy does any good.

"But some patients get better on this regime" cry the doctors

Yes. But people have a tendency to get better on their own for a huge number of conditions.

Evidence based medicine. You know it makes sense. Homoeopaths, osteopaths and other snake-oil salesmen, take note.

Cheers
( Legless Mister Stabby - shanks for the memory, Thu 20 Oct 2011, 0:14, 25 replies)

Sir William Osler
Osler is supposed to have said that much of the prestige of the medical profession is based on the fact that the patient usually gets better anyway.
(uncle_bud is not the jelly roll king., Thu 20 Oct 2011, 0:48, closed)

Why isnt this in The Lancet? Its wasted here!
( enoughblueskyforsailorstrousers, Thu 20 Oct 2011, 1:31, closed)

indeed
This for the win

(on a thursday morning?)
(OTT, Thu 20 Oct 2011, 8:46, closed)

Apparently
Literal snake-oil actually works as a pain reliever. It has eicosapentaenoic acid, which lowers inflammation.
(apeloverage committed the vile act of onanism on, Thu 20 Oct 2011, 5:09, closed)

So exactly how do you distil and then fractionate(? - c'mon I'm going back to highschool chem. here) a snake?

(Misery McUglywife an attention seeking sociopathic fuckstain., Thu 20 Oct 2011, 6:03, closed)

You don't. You squeeze them really, really hard until it comes out*.

_{* May be a load of bollocks, I don't really know}
(turtles head is touching cloth poked a dwarf on the forehead at, Thu 20 Oct 2011, 8:33, closed)

eicosapentaenoic acid
comes from fish oil, not snake oil.

Cheers
( Legless Mister Stabby - shanks for the memory, Thu 20 Oct 2011, 8:44, closed)

no, it comes from snakes too.

( scarpe We Stole Bikes, Thu 20 Oct 2011, 8:48, closed)

sea snakes then. middle ground boys, middle ground.
( enoughblueskyforsailorstrousers, Thu 20 Oct 2011, 8:59, closed)

It's an interesting question,
I have idly wondered the same thing myself.

I think it's just a question of someone getting around to thinking about it, maybe just having time to do so.

Taking it forward, it's also quite exciting to think what's in the future. If you see the difference between 17th century thinking in medicine, and todays - i.e. exactly what you're describing, think what hasn't yet been discovered. Who says in 50 years time, TV shows won't be beamed directly into our brains . . .

I like futurology, which is really just history in reverse.
(username failed moderation, Thu 20 Oct 2011, 8:54, closed)

TV shows are directly beamed into my brain when I go to sleep.
( enoughblueskyforsailorstrousers, Thu 20 Oct 2011, 9:00, closed)

Really?
I just get porn.
(username failed moderation, Thu 20 Oct 2011, 10:04, closed)

Also
A lot of medical practice is dictated by the pharma' companies. They have an enormous amount of clout. So drug A may be better at treating Illness X, but the company behind drug B are bigger so gets prescribed by the doctors.
(sittingduck Attention seeking, bullshitting fuck-knuckle, Thu 20 Oct 2011, 9:10, closed)

With The Greatest Respect
But that is total and utter crap.

Mrs Legless is a surgeon. She has no financial interest whatsoever in what she prescribes or what prosthesis she fits. She gets paid either an hourly rate or, when she's on call, fee for service. She gets no kickbacks, rebates or promotional goodies from any drug company. The regulations around what you can and can't accept from Big Pharma are incredibly strict. I think the best freebies she's ever had out of them were a wind-up torch (Australian Defence Force Recruiter) and a USB stick. A 2 gig USB stick.

Cheers
( Legless Mister Stabby - shanks for the memory, Thu 20 Oct 2011, 9:52, closed)

I blame Dr Goldacre
he lied to me then, the twat
(sittingduck Attention seeking, bullshitting fuck-knuckle, Thu 20 Oct 2011, 10:38, closed)

That's what you get for listening to Dr Goldacre and not MrsLegless, you fool.

( scarpe We Stole Bikes, Thu 20 Oct 2011, 10:40, closed)

*hangs head in shame*

(sittingduck Attention seeking, bullshitting fuck-knuckle, Thu 20 Oct 2011, 10:46, closed)

to Be Fairt
I believe the docs in the US get a cut of the price of the meds they prescribe. But that doesn't happen where you have a decent form of socialised medicine like Oz and the Uk
( Legless Mister Stabby - shanks for the memory, Thu 20 Oct 2011, 11:07, closed)

I have a trivial role in the healthservice
with no perceptible influence over procurement or delivery, but I've still had a number of free lunches from drugs companies.
Mrs Legless should attend more events.
( monster munch person, man, woman... camera... TV?, Thu 20 Oct 2011, 11:11, closed)

This may be true, but...
...in the vast majority of cases, both treatment A and treatment B have some positive effect.

I have a bit of a knee-jerk reaction to the "you're all in the pay of someone trying to sell and re-sell ineffective treatment" argument, as it usually comes from the spine wizards, amnesiac water-fondlers and human pincushion purveyors.

And it comes from them with neither a trace of irony nor a jot of evidence.
( Amish Information Systems hates misplaced, commas, Thu 20 Oct 2011, 12:42, closed)

Two points:
1) many patients will badger their doctors over inconsequential (and sometimes untreatable) conditions; the doctor will often write them a prescription just to shut them up (patients are happy when their doctor appears to be doing something for them, which is why it is something of a shame that doctors are no longer allowed to prescribe sugar pills)
2) most doctors won't have the time or resources (or expertise) to carry out a controlled study of every treatment that they prescribe, so if casual observation suggests that something is working (and there's an absence of outside guidance), it would be remiss of them not to continue with the treatment in question.

Other than that, congratulations on your understanding of the scientific method.
( monster munch person, man, woman... camera... TV?, Thu 20 Oct 2011, 9:57, closed)

Your average
GP isn't there to research.

Not all doctors are doing what he's describing.
(username failed moderation, Thu 20 Oct 2011, 10:35, closed)

Quite.
Your average GP just wants you out of their sugery as fast as possible. If they can be confident that it won't actually make you worse, and if the budget will allow for it, prescribing an ineffective treatment is a win for all concerned (assuming that you really will get better on your own).
( monster munch person, man, woman... camera... TV?, Thu 20 Oct 2011, 10:39, closed)

One factoid worth remembering.
When a study asked consultants what treatment they would give to a patient for the best outcome and what treatment that would choose for themselves, the results differed, and differed in the same way. The medical professionals chose the treatement that involves the least intervention.

In other words, they don’t mind taking the risk when it doesn’t apply to themselves.
( Ring Of Fire A petty, drooling belming butthurt retard., Thu 20 Oct 2011, 11:04, closed)

One fact worth remembering is that factoid doesnt mean a fact.
( enoughblueskyforsailorstrousers, Thu 20 Oct 2011, 12:33, closed)