A Foolish Consistency
A foolish consistency is the hobgoblin of little minds, adored by little statesmen and philosophers and divines. — Ralph Waldo Emerson (1803–1882) It is odd isn’t it? Large numbers of quality studies published in the best peer review journals consistently showing the same or similar effect and no contradictory studies. Despite the emphasis on evidence-based medicine, the entire literature is dismissed as...
Antiscience-Based Medicine in South Africa
South Africa’s Health Minister, Manto Tshabalala-Msimang, is fighting to protect the traditional healers of her country from having their methods tested scientifically. She warns that, “We cannot use Western models of protocols for research and development,” and that she does not want the incorporation of traditional healing to get “bogged down in clinical trials.” Her arguments are anti-scientific and represent a health...
Glucosamine Update: A New Study and a New Product
When I recently wrote about glucosamine, I discussed the evidence up through the New England Journal of Medicine study of 2006, which I thought was a pretty definitive study showing that neither glucosamine, chondroitin or a combination of the two was more effective than placebo. Subsequent studies have continued to fuel the controversy. One 2007 study showed that glucosamine sulfate was better than placebo for knee osteoarthritis. Another 2007 study showed...
When the popularity of new surgical procedures outpaces science
In science- and evidence-based medicine, the evaluation of surgical procedures represents a unique challenge that is truly qualitatively different from the challenges in medical specialties. Perhaps the most daunting of these challenges is that it is often either ethically unacceptable or logistically impossible to do the gold-standard clinical trial, a double-blind, randomized placebo trial for an operation. After all, the “placebo” in...
Prior Probability: the Dirty Little Secret of “Evidence-Based Alternative Medicine”—Continued
This is an addendum to my previous entry on Bayesian statistics for clinical research.† After that posting, a few comments made it clear that I needed to add some words about estimating prior probabilities of therapeutic hypotheses. This is a huge topic that I will discuss briefly. In that, happily, I am abetted by my own ignorance. Thus I apologize in advance for simplistic or incomplete...
Iraq civilian deaths II: Summing up
Call me naive, but I did not expect the volume or the emotional depth of the responses to the Iraqi civilian death post. I thought many would respond to the new NEJMed survey as I did; wondering about the validity of the previous surveys and recognizing that they have a validity problem. And, that there is a question about what is printed...
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February 21, 2008
Proposed Changes to FDA Regulation Present a Dilemma
The Food and Drug Administration (FDA) is proposing a very interesting loosening of their regulations of pharmaceutical company marketing. The pros and cons of the proposed changes present an interesting dilemma, with legitimate points on both sides. When the FDA approves a drug it is approved for a very specific medical indication. I have long thought that FDA approved indications for drugs...
Antibiotics for Sinusitis
You’re a patient. That cold just isn’t getting better and you have purulent drainage from your nose, and your face hurts and your teeth hurt. You probably have sinusitis, right? You go to a doctor to get an antibiotic. You’re a doctor. Deep down, you know there’s a good chance the patient has a self-resolving condition. You’d rather not do x-rays on every patient who...
Toxic myths about vaccines
Antivaccine activists would have you believe that vaccines are loaded with "toxins" and are therefore dangerous. While there are some chemicals that sound scary in some vaccines, they dose makes the poison, and at the tiny amounts used in vaccines none of these "toxins" are harmful.