G'day! I like the terminology of "proven to be useless", because it reduces the danger of throwing babies out with bathwater (interventions where the issue is an absence of evidence, not evidence of absence of effect). Evidence of absence of effect is unfortunately not required it seems for many people to brand things useless. Often it seems to me that the equation can be "intervention I don't believe in + no evidence of effect = useless", instead of "likely to be harmful + no evidence of benefit" or "evidence of no benefit". (No comment on vertebroplasty here – just the general point.)
Hilda
From: Jeremy Howick <[log in to unmask]<mailto:[log in to unmask]>>
Reply-To: Jeremy Howick <[log in to unmask]<mailto:[log in to unmask]>>
Date: Tue, 19 Jul 2011 11:33:27 -0400
To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: AW: solution to health care cost crisis: technical vs.philosphical..
Dear All,
I have very much enjoyed reading these useful contributions. Paul Glasziou showed us all up by stating what should be obvious to all of us – what everyone signed up to this list should be fighting for: CUT OUT TREATMENTS THAT HAVE PROVEN TO BE USELESS. It merits restating:
"We might do this by doing less useless things (cutting waste). For example, vertebroplasty for osteoporotic fractures was costing the US about $1Billion per year, but the two RCTs that used a sham control showed no benefit. This is just one of a very long list. We could also cut costs by doing the same things better - which quality improvement aims to do …. Another example is Peter Pronovosts' work to reduce central line infections, which saved lives and money (from less ICU time)."
Best wishes,
Jeremy
--
Jeremy Howick PhD, MSc, PGCert, DipSoc, BA
MRC/ESRC Postdoctoral Fellow
Centre for Evidence-Based Medicine
University of Oxford
Oxford OX3 7LF
United Kingdom
www.cebm.net
www.primarycare.ox.ac.uk/dept_staff/jeremy-howick/
eu.wiley.com/WileyCDA/WileyTitle/productCd-140519667X,descCd-authorInfo.html
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