Agree
Clinicians deal with individuals, to say to an individual that we might be
able to increase your risk/chance of survival over the next five years from
85 to 86.5% but it would mean taking a tablet every day and you have a 94%
of not benefiting at all, is inviting them to make a value judgement on the
evidence (and of course the trials are of shortish duration and not powered
to detect rarer adverse events that have a longer time lag). The validity
of the numbers is doubtful anyway, what with ethnicity, family history etc.
Our aim should be to provide information, explain it in an unbiased way, to
share the uncertainties, and to share in the decisions,. Paternalism is
still rife unfortunately.
The costs of the Statin budget are going to be huge, what of the opportunity
costs for the NHS?
Primary prevention may medicalise people, inhibiting them from retaining
control and making healthy lifestyle choices.
There is a good book "Evidence based patient choice" edited by Edwards A et
al that I can recommend.
We need to be able to communicate risks/benefits more effectively so that
patients and clinicians can exercise their value judgements on a sound
footing (or as sound as possible). How do people out their achieve this??
Regards to all
Dr OP Dempsey
Family Practitioner Researcher
BSc MSc MB BS
Lockwood Research Practice
Huddersfield
mobile: 07760 164420
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]]On Behalf Of k.hopayian
Sent: 12 June 2003 21:38
To: [log in to unmask]
Subject: Values and EBHC
This is just to share with the list my frustration at how often EBHC is
portrayed as being separate from values, even when it is being used to back
up an argument rather than attack EBHC. The assumption in many arguments is
that evidence automatically leads to a decision. It is as if values have
nothing to do with EBHC. Here is a recent example from the UK, taken from a
weekly newspaper sent to GPs
Talking about as yet unannounced changes in the threshold for treatment of
blood pressure and cholesterol, a professor of cardiology and member of the
guideline committee of the British Cardiac Society said "There is
scientific evidence that the [current] blood pressure and cholesterol
targets are of yesterday...It is increasingly unacceptable, the 30% risk
[which is the 10 yr threshold used in the UK]. It is economic and
societal-based, not evidence-based".
The comments were prompted by new guidedlines issued by the US Heart and
Lung and Blood Institutes of Health.
We still have a long way to go to correct these attitudes which underlines
the need for continuing meetings like the upcoming Conference for Teachers
and Developers of EBHC
http://www.ebhc.org/
--
B/W, Kev Hopayian
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