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Reduction in Cause-Specific Mortality = Playing Whac-A-Mole

Posted Apr 16 2012 3:00am
Several common themes run through the advice I write on two patient forums ( Avvo & HealthTap ).  For instance, use a medication/surgery only if the benefits outweigh the risks and perform a test only if the information will change your decision.  But how do you decide?  Especially w/lay press zig zagging back & forth.  Something is good for us one day, then bad the next.

Well, another issue to ponder is type & strength of evidence being reported.  I try to only point out human data published in peer-reviewed journals rather than telling you about some possible answer to achieve world peace, end hunger & cure cancer, all based upon a one week study of a few mutated drosophilia flies.  

The first question to ask is whether the study is observational in nature or a randomized controlled trial, possibly double-blind & placebo-controlled.  The former is only good for developing hypotheses or educated guesses, although there are times when the best we'll ever get is multiple observational studies, all pointing towards the same result.  Ideally, however, we'd like to base our recommendations upon the latter which gives us evidence of cause & effect.  This is the gold standard of proof.

And if you want 24 karat proof, look for reduction in all-cause mortality.  After all, we're all going to die from something, right?  It's kind of like playing Whac-a-Mole (apologies to PETA ) whereby decreasing one disease-specific mortality (whacking a mole) allows an increase in some other disease process (another mole pops up).  What you really want is a decrease in all-cause mortality (where no moles are left standing).  Stay tuned for tomorrow's post . . .
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