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The Real Question

Posted Aug 16 2013 10:25am

Speaking of times when mainstream medicine doesn’t quite live up to the marketing, a report in the current Mayo Clinic Proceedings finds not only that “many new techniques and medicines are either no more effective than the old ones, or worse;” “many doctors persist in using practices that have been shown to be useless or harmful.”

And how many is “many”? According to numbers given in the NY Times , more than 45%.

This follows other earlier studies showing that “less than 20 percent of what physicians do has solid research to support it,” and that up to 50% of all conventional care and almost all surgery has never been “evaluated by RCTs [randomized clinical trials],” the accepted “gold standard” of medical research.

Can we now put to rest the cliché about medicine being that which works?

Of course, this raises the question of why any doctor would provide sketchy treatments at all. According to the Times,

Often doctors persist with procedures that lack evidence because they seem to make sense, [lead author] Dr. [Vinay] Prasad said. “They all sound good if you talk about the mechanisms,” he said. “You have cholesterol-clogged arteries, it makes sense that if you open them up it will help. But when that was studied, it didn’t improve survival.”

Patients, too, like to talk about mechanisms, Dr. Prasad added. “They tend to gravitate toward the nuts and bolts — what does it do, how does it work?” he said. “But the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn’t ask how does it work, but whether it works at all.[emphasis added]


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