There are conjoined issues here that need to be separated.
- One is the issue of whether there really is a remarkable, well-documented dramatic
effect * a proof of principle. These are rare, but breakthroughs do exist. A key
issue here is whether it is a real effect, or whether it is a poorly documented
anecedote. Well documented effects, based for instance on statistically correct
time series studies, are a far cry from Dr. Snakeoil's anecdotes.
- Another issue relates to the extensive work necessary to demonstrate replication, safety,
and generalization of the effect, and how to best implement the intervention,
even if it is effective.
- You also raise the issue of comparative effectiveness * which indeed is a
major issue in practice.
I suspect we all agree that reasoning from individual experience or poorly documented
anecdotes or case reports of dramatically new and effective interventions is very unreliable *
often snake oil. Level 5 "evidence"?
* Mark J.
Mark V. Johnston, Ph.D.
Director of Outcomes Research, KMRREC,
Professor, Physical Medicine & Rehabilitation, UMDNJ/NJMS,
1199 Pleasant Valley Way,
West Orange, NJ 07052
Phone: 973 243 6810
Fax: 973 243 6963 R.A.: 973 243 6876
>>> M Power <[log in to unmask]> 11/15/2005 11:42 AM >>>
Mark, Rod
I think that you have acquiesced too easily in accepting that
observation of dramatic effects can provide sufficient evidence to guide
real life clinical practice. It is not rare. It is non-existent. Take
Rod's
penicillin example. It did have dramatic effects when first used. But,
what about Anothercillin; isn't that better? What is the optimum dose?
Frequency? Route? Etc, etc. The answers to these questions cannot be
provided by simple observation of dramatic effects.
I also think that many, many people every day *DO* use observation of
dramatic effects (e.g. personal testimonies and personal experience) as
sufficient evidence on which to base health care decisions. What do you
say to Mr and Ms Desperately Gullible who have read lots of personal
testimonies that Dr Snakeoil's purple pills will cure their cancer,
depression, headaches, wrinkles, arthritis, alopecia, obesity and even
the cat's eczema? How do you explain to them that dramatic effects can
never provide sufficient evidence to support a decision to spend money
and risk health? Refer them to the James Lind Library?
Puzzled?
Michael Power
-----Original Message-----
From: Rod Jackson [mailto:[log in to unmask]]
Sent: 14 November 2005 21:11
Subject: Re: Comment on Checklists for case reports or case series?
Dear Mark - your points are well taken and I agree wholeheartedly
with you. I accept my penicillin example of such a dramatic effect is
rare in real life and used it to mainly to make the methodological
point.
regards Rod Jackson
>The points I have read are well-based and thought out, and I have
enjoyed
>reading the discussion.
>
>The example of penicillin is correct and relevant. However, such
dramatic
>effects are rare
<snip>
Dr Michael Power BSc Hons, MB BCh, MD, DCH
Clinical Knowledge Author, Guideline Developer and Informatician
Prodigy Knowledge, Sowerby Centre for Health Informatics at Newcastle
Ltd
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