Communicating risk would be the great basis for a trial done over the
internet -
We all explain cardiovascular risk to patients (usually one every 30
patients or so) - we could build a simple questionnaire around that
explanation of risk - give it to the patient - and then send it back
over the internet to a central trial unit. If we all did it we could
collect 100 patients or so very quickly - the design of the
questionnaire is a little more tricky - what exactly is the question?
Martin
----------------------------------
Chair of Family Medicine
McGill University
515-517 Pine Avenue West
Montreal H2W 1S4
Quebec
Canada
514 398 7375 ext 0469
Mobile 514 781 2092
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of OP Dempsey
Sent: June 17, 2003 6:08 PM
To: [log in to unmask]
Subject: Re: Values and EBHC
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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