After my query these are the responses except from my alter-ego
MANY THANKS and a merry X-MAS
Hello,
There are many, but here is a great recent example because the lower levels
of evidence had convinced so many people that therapy was effective:
Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff
E. Related Articles
Randomized trial of estrogen plus progestin for secondary prevention of
coronary heart disease in postmenopausal women. Heart and Estrogen/progestin
Replacement Study (HERS) Research Group.
JAMA. 1998 Aug 19;280(7):605-13.
Cheers and Best Wishes,
Brian
....................................
Brian Budenholzer, MD
Director, Clinical Enhancement & Development
AC18
Group Health Cooperative; Network Services Division
PO Box 204
Spokane, WA 99210-0204
USA
[log in to unmask]
509/ 838-9100 X 7393
fax: 509/ 458-0368
Here's a quote I like -- I'm not sure which side of the "aisle" it applies
to in this conversation:
"You are never dedicated to something you have complete confidence in. No
one is fanatically shouting that the sun is going to rise tomorrow. The
<<know>> it's going to rise tomorrow. When people are fanatically dedicated
to political or religious faiths or any other kinds of dogmas or goals, it's
always because these dogmas or goals are in doubt."
Robert Pirsig. Zen and the Art of Motorcycle Maintenance, p. 134.
Allen
Allen F. Shaughnessy, PharmD
Director of Research
Associate Residency Director
Harrisburg Family Practice Residency
Harrisburg, PA 17101
Dear Kevin
Bed rest for lower back pain.
Nick Bowles, Lecturer
School of Health Studies
University of Bradford
25 Trinity Road
Bradford, BD5 0BB
Tel: 01274 236414
Fax: 01274 236360
Home Page: www.brad.ac.uk/acad/health/nbowles/index.htm
There's loads - although some are not yet entirely uncontroversial.
Here's a couple that have been nailed and that you should be able to
track down reasonably easily:
Post-operative radiotherapy for lung cancer - harmful rather than
ineffective - used as standard for years. IPD meta-analysis
published in the Lancet a couple of years ago - should come up if you
search the website.
High dose chemotherapy with transplantation for breast cancer -
standard in the states for a while - finally nailed when it was found
that the only two 'positive' trials were fraudulent. Should be
something about this on www.asco.org, and probably some comments
in the medical press. Recent trial published in the Lancet also
comments on this (seach for 'tailored FEC' on the Lancet website - or
'Bezwoda' for reports on the fraud).
Regards
*******
Josie Sandercock
Research Fellow (Medical Statistics)
Department of Public Health & Epidemiology
University of Birmingham
Edgbaston, Birmingham B15 2TT
Tel: 0121 414 2247
Fax: 0121 414 7878
E-mail: [log in to unmask]
Kevin.
Carotid Endarterectomy by Neosurgeons comes to mind for arterial stenosis
and TIAs management. Was it not the completion of some well conducted RCTs
that established the procedure's ineffectiveness and potential harm -
which had been a cash cow for several decades (i.e., pre-late 1980s).
Since this is not my area of study, the procedure may have been
rehabilitated with new information. But, it was a good example
of doing a procedure for many years prior to proper study of its utility.
Another would be the use of the polysaccharide Pneumococcal vaccine to
prevent acute Otitis Media in children. This may change with the
availability of the conjugate vaccine, which appears to be effective but
expensive.
A final potential example that I seem to remember from a few years back
was the use of single vessel coronary artery grafting verses medical
management. The Americans in Detroit, Michigan had gone from triple
vessel to double to single, as opposed to the Canadians on the other side
of the border in Windsor, London and Toronto Ontario. There appeared to
be evidence that doing single vessel disease surgically was actually
harmful compared with drug therapy. I would direct you to the Institute
of Clinical Evaluative Studies (ICES) in Ontario for this and potentially
other such studies into ineffective but "intuitively beneficial"
interventions. Try the search engine (www.google.com) and type in the
above or "David Naylor" to find their homepage. It escapes me at this
time.
Hope this is helpful.
Rudy.
Kevin,
A peculiar side track of your topic is the tomato effect, a type 4 error.
The result of empirical research on effectiviness of a treatment is false
negative.
2 references about type 3 & 4 errors.
Goodwin JS, Goodwin JM. The tomato effect. rejection of highly effacious
therapies. JAMA 1984; 251: 2387-90.
Robin ED, Lewiston NJ. Type 3 and type 4 errors in the statistical
evaluation of clinical trials. Chest 1990; 98: 463-5.
Nico van Duijn
Prof S.J. Capewell
lignocaine post MI
Suggest
a) D&C under 40
b) hormonal therapies for menorrhagia.
Siobhan Jennings
you could try looking at www.eboncall.co.uk
(browse down to meningitis -> diagnosis and look at he bed-rest stuff -
commonly preformed but useless - and compare with the fine needle stuff -
rarely done but effective)
cheers
bob
Well, I was going to send you along the classic sixth stool guiac
reference, (and I do so below) but I append above it a new paper that
seems to merit a read and calls into question my initial decision. Good
luck, I think I would like to hear if you find any pearls.
-----------------
J Health Econ 1990;9(4):429-45
The sixth stool guaiac test: $47 million that never was.
Brown K, Burrows C
Monash University, Clayton, Victoria, Australia.
In a 1975 paper, Neuhauser and Lewicki analysed a colorectal cancer
screening policy approved by the American Cancer Society. Their
analysis yielded an incremental cost per case detected in excess of $47
million. This vivid demonstration of the impact of marginal analysis is
frequently cited by health economists and is often used for pedagogic
purposes. The analysis is incorrect because of two fundamental errors.
We have reanalysed the protocol in two stages. After correction for
these errors, the $47 million disappears, the marginal cost is quite
modest and the policy appears to be defensible on economic grounds.
On 14 Dec 2000, at 15:40, Kelleher, Kevin wrote:
----------
N Engl J Med 1975 Jul 31;293(5):226-8
What do we gain from the sixth stool guaiac?
Neuhauser D, Lweicki AM
The six sequential stool guaiac protocol has been advocated for
screening of colonic cancer. Analysis of the expenditures involved in
such a program shows that the cost of detecting cancer rises
exponentially so that the marginal cost of the sixth test may be 20,000
times the average cost. The marginal cost is decreased with lower test
sensitivity and increased with lower prevalence of colonic cancer.
This result shows that even an inexpensive test can become quite
costly in terms of cases detected. The marginal cost per case detected
depends on the prevalence of the condition in the
population screened and the sensitivity of the test applied.
[log in to unmask]
Hi Kevin. I was dealing with something about lung cancer when
your message came. In this area, two things came to mind:
1. lung cancer screening (a good ref. Marcus et al. JNCI
2000;92:1308-16)
2. beta carotene supplementation in smokers for the prevention of
lung cancer: positively harmful instead (ATBC and CARET trials)
Do let me know what others come up with.
Please send me love to Tessa and the kids. Have a peaceful
christmas and 2001.
kk
K K Cheng
Professor of Epidemiology
Department of Public Health & Epidemiology
Public Health Building
The University of Birmingham
Edgbaston
Birmingham B15 2TT
UK
Tel +44 121 414 6757
Fax +44 121 414 7878
email [log in to unmask]
There are some good examples of how practices in widespread use were shown
to be ineffective through RCTs at the following website:
http://www.hsc.usf.edu/~bdjulbeg/oncology/practice-change.htm
The most commonly used examples of ineffective practice that I have seen
involve routine use D&Cs and use of anti-arrythmic drugs during MIs.
Slan go foil
Mary
Dr Mary Dixon-Woods
Lecturer in Health Policy
Department of Epidemiology and Public Health
University of Leicester
22-28 Princess Road West
Leicester LE1 6TP
Tel: 0116 2523204
Fax: 0116 2523272
Email: [log in to unmask]
The Bandolier website is a good place to start and there is a good essay by
Andrew Moore on the consequences of ineffectiveness etc.
http://www.jr2.ox.ac.uk/Bandolier
Ceri
Dr Ceri Phillips
Centre for Health Economics and Policy Studies
School of Health Science
University of Wales Swansea
Singleton Park
Swansea SA2 8PP
Tel: +44(0)1792 295729
Fax: +44(0)1792 295487
The Bandolier website is a good place to start and there is a good essay by
Andrew Moore on the consequences of ineffectiveness etc.
http://www.jr2.ox.ac.uk/Bandolier
Ceri
Dr Ceri Phillips
Centre for Health Economics and Policy Studies
School of Health Science
University of Wales Swansea
Singleton Park
Swansea SA2 8PP
Tel: +44(0)1792 295729
Fax: +44(0)1792 295487
Slainte
Kevin
Dr Kevin Kelleher
Stiurthoir Slainte Poibli(DPH)
Mid-Western Health Board
31 Catherine Street
Limerick
IRELAND
Tel: +353-61-483338
Fax: +353-61-483211
E-Mail: Mailto: [log in to unmask]
Web: http://www.mwhb.ie
Web: http://www.icsp.ie
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