Comments on: Two reasons why using “Evidence Based Medicine” to make rationing decisions worries me

By: Four steps to improve Evidence Based Medicine « Heroes Not Zombies

Four steps to improve Evidence Based Medicine « Heroes Not Zombies — Sun, 25 Sep 2011 17:03:24 +0000

[...] Many researchers have found that, using Freedom of Information requests, it turns out that drug companies just don’t publish all the data. (see my second point in that link to an earlier post). If only the studies showing better results [...]

By: 1smartcookie

1smartcookie — Mon, 14 Jun 2010 13:11:21 +0000

Well said Bob! The good thing is that it seems these arguments about the limits of EBM are coming from across medicine…can we hope that decision makers might take notice? I guess we are all tying to make them take notice. Cheers on keeping up the fantastic dialogue, it is energising to read.

By: jim

jim — Mon, 14 Jun 2010 08:26:34 +0000

Great post Bob really resonates with me working in a busy orthopaedic clinic where weak so called evidence based protocols and social mobility swamp individual narratives. Hummility ? well not part of the training…… Delusion ? if it doesnt work its the patients fault , very little need for self reflection with all that evidence around !!

By: Tracy Allison Altman

Tracy Allison Altman — Fri, 11 Jun 2010 21:34:00 +0000

Excellent analysis. Just yesterday I wrote a post on Evidence Soup about how easy it is to love the “evidence-based” concept. But turning it into a repeatable process? Not so much.

By: interpretartistmama

interpretartistmama — Fri, 11 Jun 2010 19:24:58 +0000

An anecdote (I think it’s a true story, but can’t find source): For his retirement present, the scientists at Cold Spring Harbor decided to give Dr. Jim Watson his own genome, fully mapped. When the analysis was done, however, it turned out that his genes coded for over 20 diseases/conditions that should have killed him years ago. Fortunately he didn’t know about it then, and just kept on living

Here’s to human unpredictability!

As for individualized medicine, my father works as a Senior Scientist at the Cedar-Sinai Hospital in LA, where they have access to a huge DNA database and medical history of thousands of patients, and are working on this very issue. He echoes your sentiments on the benefits and even necessity of individualized medicine, but agonizes over the fact that pharmaceutical companies just aren’t buying it. Literally. For them it is much more profitable to stamp out a thousand “heal-all” pills that won’t work for half the population, than to do all of the research/testing/production for 20 different types of medications, where each would target only a very specific (and small) population.

The trick is to make individualized medicine profitable for the industry (unfortunately, the health of the people buying the treatment is not sufficient reason to move in that direction). My father proposes to go to insurance companies, and convince them that with individualized medicine you will have fewer recurrent conditions, relapses, complications, etc. (which means less claims sent to the agencies), and that the insurance companies in turn should be the ones pressuring the pharmaceutical industry to buy into this idea…

By: Kaviraj

Kaviraj — Fri, 11 Jun 2010 14:27:28 +0000

There is so much that contradicts the claims of ConMed that if those standards would rigorously be applied, more that half the treatments would be thrown out. Then we are left with what?

Evidence-based? The evidence shows that 90% of drugs do not work for the conditions they are prescribed for. An example is the use of antibiotics to treat a cold.

Recently, industry captains cynically admitted that 90% of drugs don’t work for what they are prescribed for, yet these same people continue to push them. If your local crack dealer does the same, he gets arrested.

The Pharmaceutical industry may have legal sanction to sell drugs, but they have no moral sanction to deliberately poison the people.

By: trapperhoney

trapperhoney — Fri, 11 Jun 2010 13:59:52 +0000

amen to that! not all treatments work for everyone. how many drugs were deemed “safe” by the FDA only to be recalled a few years later due to horrendous side effects and even death?? it needs to be up to the individual as to what treatment they want to pursue.