Sam Wiebe and Bruce Arroll have just submitted citations for two other
trials that they believe considerably changed medical practice. In the
interest of stimulating further debate on this issue (and hoping to get some
more nominations from the rest of the group), I would like to draw your
attention to these two new trials. I thank Sam and Bruce and look forward to
further contributions.
Thanks
ben
ps May I suggest that each new nomination is sent both to me and to the
group in order to avoid unnecessary posting from my end. However, I will
periodically try to post web address of the "lists of evidence that changed
medical practice" for those folks who might have missed it during initial
debate.
--------
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. (SW)
Crane J. Pearce N. Flatt A. Burgess C. Jackson R. Kwong T. Ball
M. Beasley R. Prescribed fenoterol and
death from asthma in New Zealand, 1981-83: case-control study
[see comments]. Lancet. 1(8644):917-22, 1989
Apr 29. 89218316
This article suggested that fenoterol was harmful and subsequently
fenoterol virtually disappeared as an asthma drug in new zealand
and possibly in other countries. This was hotly debated. Walter
spitzer later did a cohort study in canada (saskatchewan) and
claimed there was no difference between salbutamol and fenoterol
on a dose for dose basis. Not sure who was right but fenoterol
disappeared as there were clear (and safe?) alternatives eg
salbutamol (BA)
To see the lists of the "trials that changed the practice", go to
http://www.hsc.usf.edu/~bdjulbeg/oncology/practice-change.htm
Thanks
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
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