Gorski provides insight and analysis on evidence based medicine, that might promote better medical decision making, even reduce waste and unnecessary even risky procedures or treatments.
I liked it.
An experiment in paying through the nose for “unnecessary care”
Points well made.
Thanks. I believe good evidence is evidence that also describes the limits of the conclusions one might draw, and i think statistical significance can sometimes cause great mischief. Just because I have powered up my study doesn’t mean I have cleaned up my methods or tuned up my analysis and conclusions. It might also be a good idea to have present end points and not moving ones and proper limits to prevent multiple endpoints creating fraudulent positives.
Clinical studies are usually cleaner and more reliable than epidemiological ones, but insider know that–its the media and the politicians that don’t.
It is the best we have. However, a few caveats. I had a professor who use to say that even if a treatment is effective for only 20%, for that 20% it was 100% effective. Much of our knowledge on outcomes assume cause and effect. Yet in some research on treatment for bipolar disease, placebo was as much as 75% effective.
Not enough has been written about biased and poorly designed medical research that later becomes reference for more research papers and eventually used as standard of care.
In my field of Neurosurgery the n is often too small to make any significant conclusions, yet we still do.
Then there is the research that can never be done, for instance with-holding certain care seen as standard or human experimentation. There are some questions that currently are then unanswerable.
Evidence based medicine relies on that the data presented is always unbiased and honest with identifiable flaws. Hopefully this is usually mostly true.