Quite so!
That is why we need a strong bond between epidemiologists and
physicians to soften the sharp edges of uncertainty in patient care. Acting
from mean outcomes from mean population is one, applying & explaining it
to your patients is another. Together it could be good patient care.
nico van Duijn
Organization: The University of Birmingham
Date sent: Thu, 22 Jun 2000 13:14:15 GMT
Send reply to: [log in to unmask]
Priority: normal
Subject: Re: population - individual benefit
From: "David Braunholtz" <[log in to unmask]>
To: [log in to unmask]
>
> There is a danger of completely misunderstanding the nature of the
> problem here. It amounts to a 'trap' that is frequently fallen into -
> that 'somehow' we should be able to know for each individual patient
> whether a treatment will work or not. There is no 'somehow', now or
> ever, that will allow this - which is why we need to use probabilities
> when discussing EBH.
>
> What is relevant to treatment decisions is what is known about the
> possibility of success AT THE TIME OF DECISION. Although with
> hindsight (if treatment is given) we (may) know whether the treatment
> works or not, at the time of the decision we DONT. In fact, even with
> hindsight it is usually not easy to know whether a treatment worked
> for someone, hence the need for randomised trials.
>
> Bayesians define probability as degree of belief - it is personal,
> and can change over time. Bayesian probability is thus the relevant
> quantity (together with values for outcomes) for decision makers -
> like patients deciding whether or not to take a treatment.
>
> As Toby Lipman says, we can try to define high-risk groups, and
> find characteristics which help predict whether a treatment will work
> (sub-group analyses - though much care is needed with interpretation).
> However, even with all this, in the end there are very few if any
> treatments where it is known with complete certainty what the outcome
> will be - and I don't see this changing, even with increased genetic
> knowledge.
>
>
> David Braunholtz
> Department of Public Health & Epidemiology
> Public Health Building
> University of Birmingham
> Birmingham B15 2TT
> E-Mail: [log in to unmask]
> Tel: 0121-414-7495
> FAX: 0121-414-7878
Dr.N.P. van Duijn, General Practitioner
Department of General Practice
Division Public Health
Academic Medical Centre
University of Amsterdam
Meibergdreef 15
1105 AZ Amsterdam
& Primary Health Care Centre 'de Haak'
Almere
the Netherlands
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