Amy, All,

I think you (appropriately) bring it back to the NEJM Perspectives article that started this thread (cases can and will, and sometimes should affect decisions).

 

You also remind us that there is “the evidence” and how to best use it, and then…how it ends up getting used in practice.  Just because someone uses RCT evidence incorrectly is not reason to not rely on RCTs for what we know they can tell us.  It is further reason to teach how to practice EBM properly in my view (conscientious, explicit use of the current best…..).

Best

Rich

 

 

Dear  All,

 

The question that comes to my mind  very interesting elephant and all is what are the long term  (as in the over two years efficacy results)  for this product  in comparison with controls, those with existing CVR within the groups  and mortality rates in general? I would rethink the hypothesis about the availability heuristic for decision one choices being stronger for case reports/clinical practice experience as I can’t tell you the number of medical professionals that go by what their peers think according to the latest RCT or Meta analysis that they have likely never analysed but that a drug rep pointed out to them  rather than by what is happening in front of them with their own patients.

 

Decision making is important and both system one and system two are critical for efficiency and excellence. To me the key is to be aware of which system is in use and to know when to switch system camps as in know when to hold and when to fold. Some of this thinking is below conscious attention but there are ways to increase awareness and sharpen these skill .

 

I find  huge studies are not always good studies and that case reports/series can be very informative and bring light to nuanced areas a larger study has not controlled for.

 

Or in the words of Ravi in another email “The art of medicine lies in individualizing the evidence to a single individual”

 

Best regards,

Amy

 

Amy Price

Http://empower2go.org

Building Brain Potential

 

 

 

 

More on the availability heuristic just published today…

 

http://ebm.bmj.com/content/early/2011/07/07/ebm-2011-100073.extract?papetoc

 

best,

Rich

 

Richard Saitz MD, MPH

Professor of Medicine and Epidemiology

Editor, Evidence-Based Medicine, British Medical Journal Group

 

Boston University Schools of Medicine and Public Health

Boston Medical Center

 

 

 

 

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