Here's another RCT that changed medical (surgical) practice. Optic nerve
decompression was a favoured and widespread treatment prior to this
trial which proved its uselessness and potential harmfulness:
Optic nerve decompressive surgery for nonarteritic anterior ischemic
optic neuropathy (NAION) is not effective and may be harmful. The
Ischemic Optic Neuropathy Decompression Trial Research Group [see
comments]. JAMA 1995; 273: 625-632.
Thanks
Sam Wiebe
"Djulbegovic, Benjamin" wrote:
>
> Dear colleagues,
>
> Several months ago I attempted to perform a survey regarding the
> issue so often discussed among the members of this discussion group. That
> is, among hundred of thousands of the trials that we so far performed, can
> we actually identify those great ones that have had the major impact on
> medical practice. Many people responded to a survey-some with a concrete
> examples and some with general comments or thoughts regarding this
> initiative. I thank them all, and hope they will continue to contribute to
> future modifications and update of the list.
>
> Undoubtedly, this is enormous and ambitious task and a survey such
> as this cannot come even close to identify all evidence that has been
> accumulated over years and that changed our practice. Yet, the issue will
> not go away, and will likely will be asked more forcefully in years to come.
> So, as imperfect as it may be, here is a list of the trials which in opinion
> of some members of this group could qualify as EVIDENCE THAT CHANGED OUR
> PRACTICE. To review it, please go to
> http://www.hsc.usf.edu/~bdjulbeg/oncology/practice-change.htm
>
> You will notice there are actually two lists (1. RCT that changed
> the practice, 2.Non-RCT that changed our practice). Of interest is that a
> list of Non-RCT with the major impact on medical practice is much shorter.
> Could it be that is because breakthroughs in medicine are so rare, and that
> most of advances in therapeutics can only come from a rigorous empirical
> testing in RCTs? Perhaps the lists provided here can further contribute to
> this key, albeit admittedly a combative issue- where should resources be
> allocated: to basic science research vs. clinical research (so called, NIH
> vs. Cochrane model).
>
> I am hoping that exposing these lists to open discourse, over time,
> perhaps we may actually compile the COMPLETE and universally ACCEPTED list
> of all trials that changed clinical practice.
>
> I would appreciate any further thoughts and contribution to this
> initiative. Thanks.
>
> ben djulbegovic
>
> Benjamin Djulbegovic, MD,PhD
> Associate Professor of Medicine
> H. Lee Moffitt Cancer Center & Research Institute
> at the University of South Florida
> Division of Blood and Bone Marrow Transplant
> 12902 Magnolia Drive
> Tampa, FL 33612
>
> Editor: Evidence-based Oncology
> http://www.harcourt-international.com/journals/ebon/
>
> e-mail:[log in to unmask]
> http://www.hsc.usf.edu/~bdjulbeg/
> phone:(813)979-7202
> fax:(813)979-3071
--
++++++++++++++++++++++++++++++++++++++
Samuel Wiebe MD, MSc, FRCPC
Clinical Neurological Sciences
University of Western Ontario
London Health Sciences Centre
University Campus
339 Windermere Rd.
London, Ontario, CANADA
N6A 5A5
Tel (519) 663-3984
Fax (519) 663-3753
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