And so it goes on....
Thanks for all the comments, I'm finding this very interesting.
A theme common to many of the examples, including Jim's, seems to be
assuming patient-oriented outcomes (POOs) from pathophysiological
principles and surrogate outcomes (DOOs eg effects on HbA1c)
In the paper describing the SORT classification,
(http://www.aafp.org/afp/2004/0201/p548.html) Ebbell et al list 13
examples where DOOs have misled us (either encouraging dangerous
treatment eg lidocaine infusion post-MI or discouraging helpful
treatment eg beta-blockers in heart failure). Full references are
given.
See our blog for a summary http://www.npci.org.uk/blog/?p=352
To add my own example, I'd nominate the idea that increasing the COX-2
selectivity of NSAIDs would improve their safety. Couple that
pharmacologically attractive idea with enormous marketing (bigger budget
for Vioxx than Nike or Coca Cola's TOTAL budget)and hence enormous
take-up and you end up with probably the biggest drug withdrawal in
history and a large number of excess or premature CV events and deaths,
running into 100s of thousands of people.
Hope this helps
Andy
Andy Hutchinson
email: [log in to unmask]
tel: 07824 604962
web: www.npc.co.uk or www.npci.org.uk
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jim Walker
Sent: 11 June 2010 15:33
To: [log in to unmask]
Subject: Re: Popular but ineffective treatment?
Has someone already mentioned the history of rosiglitazone (and least in
America), perhaps now entering its death throes?
Jim
James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
...it's all very well planning what you will do in six months, what you
will do in a year, but it's no good at all if you don't have a plan for
tomorrow.
Hilary Mantel. Wolf Hall.
>>> "Djulbegovic, Benjamin" <[log in to unmask]> 6/11/2010 7:59 AM
>>>
Just spotted an editorial in Lancet referring to WHO report on rational
use of medicines:
(http://www.who.int/mediacentre/factsheets/fs338/en/) according to
which
*More than 50% of all medicines are prescribed, dispensed or sold
inappropriately, and half of all patients fail to take medicines
correctly.
*The overuse, underuse or misuse of medicines harms people and wastes
resources.
*More than 50% of all countries do not implement basic policies to
promote rational use of medicines.
*In developing countries, less than 40% of patients in the public
sector and 30% in the private sector are treated according to clinical
guidelines.
*A combination of health-care provider education and supervision,
consumer education, and an adequate medicines supply is effective in
improving the use of medicines, while any of these interventions alone
has limited impact.
Ben
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul
Glasziou
Sent: Friday, June 11, 2010 7:52 AM
To: [log in to unmask]
Subject: Re: Popular but ineffective treatment?
Dear Martin & Richard
I think a more systematic study would be a nice idea! But this current
request is to garner examples for *teaching*: to illustrate how
treatments can rise (and hopefully fall) despite weak evidence. I think
many of us use the same (now tired) examples, such as flecainide and
HRT, and some newer ones would be helpful - both to save us from
boredom, but also to illustrate that it still happens. For example, the
nesiritide is a good example from this century, with the rise and fall
happening in the last decade. Also, its helpful to have examples from a
range of areas.
The references to the definitive evidence (plus any supplementary
articles) would be very helpful - thanks!
I'll post the full list of suggestions on Monday.
Paul Glasziou
Richard Nicholl wrote:
> agree..
> correct me if wrong ( I am merely a neonatal paediatrician) BUT I
> believe there /is/ a _treatment effect_ for
> high dose Vit C and cold ( reduces length of symptoms)
> antiobiotics and SORE THROAT (as opossed to "common cold"- whatever
> that is....people may want rid of their symptoms rather than their
> diagnostic label)
> I think folk should provide references to justify their (negative)
> evidence, including me but I am between pts in outpatients!
> interesting idea though...will try to get some paediatric ones
>
>
------------------------------------------------------------------------
> *From:* Evidence based health (EBH) on behalf of Martin Dawes, Dr.
> *Sent:* Fri 11/06/2010 12:01
> *To:* [log in to unmask]
> *Subject:* Re: Popular but ineffective treatment?
>
> what worries me about this is the highly anecdotal way it is
happening
> What about taking this methodically
> looking at the top 100 prescriptions, and the top 100 over the
counter
> medications, and the top 100 mechanical Txs (ultrasound for example)
> and assessing them?
> Martin
>
>
> On 11 Jun 2010, at 02:33, Lubna Al-Ansary wrote:
>
> Bed rest for acute back pain
> Routine D & C for missed abortion
> Lidocaine for arrythmia post MI
>
>
> Sent from my iPod
> Dr Lubna Al-Ansary
>
> Begin forwarded message:
>
> From: Tom Jefferson
> <[log in to unmask]<mailto:[log in to unmask]>>
> Date: ** ****** **** GMT+**:** *:**:** *
> To: <mailto:[log in to unmask]>
>
[log in to unmask]<mailto:EVIDENCE-BASED-HEALTH@JISCMA
IL.AC.UK>
> Subject: Re: Popular but ineffective treatments?
> Reply-To: Tom Jefferson
> <[log in to unmask]<mailto:[log in to unmask]>>
>
> Vit C for the commom cold (you have to take tons of the stuff and
then
> you get gallstones because of bile low PH) - poor Linus Pauling
>
> On 11 June 2010 07:58, Bruce Arroll
>
<<mailto:[log in to unmask]>[log in to unmask]<mailto:b.arroll
@auckland.ac.nz>>
> wrote:
> Dear paul and chris
>
> Cough suppressants for the common cold (a billion dollar industry)
> Antibiotics for the acute common cold
> Routine episiotomy in low risk pregnancies
>
>
> bruce
>
> -----Original Message-----
> From: Evidence based health (EBH)
>
[mailto:<mailto:[log in to unmask]>EVIDENCE-BASED-HEAL
[log in to unmask]<mailto:[log in to unmask]>]
> On Behalf Of Chris Del Mar
> Sent: Friday, 11 June 2010 12:23 p.m.
> To: <mailto:[log in to unmask]>
>
[log in to unmask]<mailto:EVIDENCE-BASED-HEALTH@JISCMA
IL.AC.UK>
> Subject: Re: Popular but ineffective treatments?
>
> Paul
>
> 1 tidying lavage arthroscopy for OA knee
> 2 vertebroplasty for painful osteoporotic vertebral fractures
> (Buchbinder R, N Engl J Med 2009;361:557-68)
>
> Chris
>
> -----Original Message-----
> From: Evidence based health (EBH)
>
[mailto:<mailto:[log in to unmask]>EVIDENCE-BASED-HEAL
[log in to unmask]<mailto:[log in to unmask]>]
> On Behalf Of Paul Glasziou
> Sent: Friday, 11 June 2010 12:31 AM
> To: <mailto:[log in to unmask]>
>
[log in to unmask]<mailto:EVIDENCE-BASED-HEALTH@JISCMA
IL.AC.UK>
> Subject: Popular but ineffective treatments?
>
> Dear All
> Following the influenza discussion, I wanted to ask for ideas of
> treatments that became (or are) popular but where evidence showed
them
> ineffective.
> For example,
> 1. Autologous bone marrow transplantation for breast cancer
> 2. Evening primrose oil for menstrual symptoms
> 3. Neuroblastoma screening in infants
> 4. HRT for prevention of CVD in menopause
> These examples are from Testing Treatments which is downloadable
(free
> pdf!) at:
>
<http://www.jameslindlibrary.org/testing-treatments.html>http://www.jame
slindlibrary.org/testing-treatments.html
> The book is being updated, and we are looking for new examples.
> I will compile the list and send to everyone.
> If you can include the reference (or clues to it) I'd be grateful
> Many thanks
> Paul Glasziou,
> CEBM
>
>
>
> --
> Dr Tom Jefferson
> Scientific Editor PLoS ONE
> Reviewer, Cochrane Acute Respiratory Infections Group
> tel 0039 3292025051
>
>
>
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