“Continuing practices that have been shown to be ineffective or unsafe is outrageous, and regularly provokes outbreaks of ire and umbrage in this forum and the better journals. Paul Glasziou himself has said in this forum that there is a very long list of ineffective treatments, but the longest list I have seen has 5 entries. Why is there no research project to publish a list of ineffective or unsafe treatments?” (Powers,2012)
I like this idea a lot particularly considering Ben’s qualifier. I think if those on the list submitted a few useless and dangerous treatments and a reference we would have a list in no time. I think instead what I see often is one group calling the other’s intervention useless with weak evidence instead of a focus on what actually doesn’t work at all. A list like this could be a public service especially if published via Open Access...
Amy
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Djulbegovic, Benjamin
Sent: 05 January 2012 09:20 AM
To: [log in to unmask]
Subject: Re: Reversals of Established Medical Practices: Evidence to Abandon Ship
Dear Michael & Ash,
i have been long mulling over these issues. Re the point made in the JAMA piece (and long noted by John Ioannidis and others), the answer can probably be found in the writing of philosphers of science. Thomas Kuhn (and many others) made a point that "truth" alone never wins; it is change in norms, values, new practices etc that eventually determine the "paradigm shift". As Max Planck famously said that one has to await for all scientific enemies to die before new ideas become accepted...
Re large number of health care interventions that could be disinvested, I think the problem is not so that these interventions are ABSOLUTELY AND ALWAYS useless. The problem is that they are approved (probably validly) for one sorts of indications, and then in a response to clinical uncertainties indication creep takes over, and we have the current situation. As long as practice of medicine is seperated from the regulatory practices for drug approval (and I am not arguing that it should be?), we will have continue to witness a tremendous waste in practice of medicine (as false positives are so much easy to swallow than false negatives).
best
ben
________________________________________
From: Michael Power [[log in to unmask]]
Sent: Thursday, January 05, 2012 5:03 AM
To: Ash Paul; Djulbegovic, Benjamin
Cc: Evidence based health (EBH)
Subject: Re: Reversals of Established Medical Practices: Evidence to Abandon Ship
Thanks Ash
I had spotted the BMJ collection and the JAMA paper, which provides a
seldom heard opinion that "there are thousands of clinical trials, but
most deal with trivialities or efforts to buttress the sales of
specific products". (I must say that I think the JAMA authors are a
few decimal points out in their estimation of the number of clinical
trials.)
The contrast between the BMJ papers and the JAMA paper makes me think
that obviously outrageous stuff draws attention away from much bigger
but boring problems.
Eg 1: Selecting data for publication or suppressing data from
publication is outrageous, and pollutes the literature. But I suspect
that the world would be a better place if 99% of the papers indexed in
Medline were to vanish. Identifying the 1% to preserve and the 99% to
censor is a dull, hard, unrewarding problem, so no-one thinks about
it. Iain Chalmers' and Paul Glasziou's advice to avoid perpetuating
the problem seems to have fallen on deaf ears.
http://www.ncbi.nlm.nih.gov/pubmed/19525005
(behind a $€£wall)
Eg 2: Continuing practices that have been shown to be ineffective or
unsafe is outrageous, and regularly provokes outbreaks of ire and
umbrage in this forum and the better journals. Paul Glasziou himself
has said in this forum that there is a very long list of ineffective
treatments, but the longest list I have seen has 5 entries. Why is
there no research project to publish a list of ineffective or unsafe
treatments? Why don't the holders of the healthcare purse strings
commission someone to build such a list? Perhaps the problem is harder
and more boring than it looks at first sight. NICE claim to have
identified "over 800 clinical interventions for potential
disinvestment". But, when they looked a little deeper they concluded
"there are few obvious candidates for total disinvestment; antibiotics
and diagnostics predominate".
This blank seems to have discouraged NICE from pursuing the matter.
http://www.bmj.com/content/343/bmj.d4519#
(might be behind a $€£wall)
Eg 3. Most research and scholarly work is behind a high paywall. But
only George Monbiot and Ben Goldacre find this outrageous --- *irony
alert* I am slightly exaggerating the general apathy to highlight the
fact that the general level of concern is really not up to the level
of the problem.
http://www.guardian.co.uk/commentisfree/2011/aug/29/academic-publishers-murdoch-socialist
Regards
Michael
On 1/4/12, Ash Paul <[log in to unmask]> wrote:
> Dear Ben and Michael,
> Presumably you have seen this recent JAMA article.
> Also this week's BMJ articles on missing clinical trial data is worth
> reading in full.
> Regards,
> Ash
>
>
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