Thursday, August 5, 2010

Evidence Versus Belief

This is a good article about medicine.  Some excerpts:

Nieman, director of the Human Performance Lab at Appalachian State University, eventually did recruit the subjects he needed for the study, comparing pain and inflammation in runners who took ibuprofen during the race with those who didn't, and the results were unequivocal. Ibuprofen failed to reduce muscle pain or soreness, and blood tests revealed that ibuprofen takers actually experienced greater levels of inflammation than those who eschewed the drug. "There is absolutely no reason for runners to be using ibuprofen," Nieman says.

The following year, Nieman returned to the Western States race and presented his findings to runners. Afterward, he asked whether his study results would change their habits. The answer was a resounding no. "They really, really think it's helping," Nieman says. "Even in the face of data showing that it doesn't help, they still use it."


Not long ago, Deyo's wife developed a shoulder condition that left her in terrible pain for nearly a year. After exhausting other options, she decided to look into acupuncture, but before she could start, the pain suddenly eased. "She jokes that if she had started the acupuncture two weeks earlier, she would have been convinced that acupuncture cured her," Deyo says.

Whether or not the "do something, anything" approach is effective, aggressive action feels empowering to doctor and patient alike. In fact, studies have shown that patients who get more high-tech spine imaging are more satisfied with their care than those who don't, even though their outcomes are no better, and in some cases worse, than those who didn't get the imaging, Deyo says. "The people in these clinical trials have worse outcomes, but they're more grateful — they think they had the best care."


"Victims of overdiagnosis don't say, 'Look what the system did to me.' They say, 'Thank God the doctor saved me,'" says Thomas B. Newman, a physician and narrative medicine expert at the University of California, San Francisco. "Nobody can say I had an unnecessary mastectomy, and nobody would want to; it doesn't make a good story."

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