- Bad Medicine
- Songtext von Bon Jovi - Bad Medicine Lyrics
- Mapping Bad Medicine Laws
- Bad Medicine, Part 1: The Story of 98.6 (Ep. 268)
- Bad medicine
Your love is like bad medicine Bad medicine is what I need Shake it up, just like bad medicine There ain't no doctor that can cure my disease I ain't got a fever got a permanent disease It'll take more than a doctor to prescribe a remedy I got lots of money but it isn't what I need Gonna take more than a shot to get this poison out of me I got all the symptoms count 'em 1, 2, 3 First you need That's what you get for falling in love Then you bleed You get a little but it's never enough.
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Website optional. Alle 11 News anzeigen. Then something remarkable happened which was the first use of controlled clinical trials in medicine. In most developed countries, we tend to think of medicine as a rigorous science, and of our doctors as, if not infallible, at least reliable.
JENA: I think that the typical patient probably does look to their doctor for answers and they value very highly what that opinion is. The Cochrane Collaboration was founded in Britain but is now a global network. BERO: … are really the evidence base for evidence-based medicine. We were the first to regularly update these reviews.
Songtext von Bon Jovi - Bad Medicine Lyrics
We were one of the first to have post-publication peer review and a very strong conflict-of-interest policy. And actually we were one of the first journals that was published only online. Compare that to how things used to work — looking up some 5- or year-old medical journal to find one relevant article that may well have been funded by the pharmaceutical company whose drug it happened to celebrate.
How is Cochrane funded? Which means, in theory at least, that the evidence assembled by the Cochrane Collaboration is pretty reliable evidence. As opposed to …. What the doctor had been taught 30 years previously in medical school. What they had been told to do by, or advised to do, by a drug-company representative that had visited them a week previously.
He was a medical student in the early s. When Chalmers observed his elders in practice, he was struck by how much variance there was from doctor to doctor. Or they may take different views about the way the baby should be monitored during labor. Or the extent to which drugs should be used during pregnancy for one thing or another.
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So lots and lots of differences in practices. When he became a doctor himself, Chalmers worked at a refugee camp in Gaza. And, as he discovered …. CHALMERS: I had been taught at medical school never to give antibiotics to a child with a viral infection, which measles is, because you might induce resistance, antibiotic resistance. But these children died really quite fast after getting pneumonia from bacterial infection, which comes on top of the viral infection of the measles. And those studies suggested that children with measles should be given antibiotics. But Chalmers had never seen those studies.
This led Chalmers to embark on a years-long effort to systematically create a centralized body of research to help attack the incomplete, random, subjective way that too much medicine had been practiced for too long. He was joined by a number of people from around the world — many of whom, by the way, were more versed in statistics than in medicine. And that resulted at the end of the s in a massive, two-volume, one-and-a-half-thousand-page book.
At the same time, we started to publish electronically. And so the Cochrane Collaboration became the first organization to really systematize, compile, and evaluate the best evidence for given medical questions. It took a long while, but the Cochrane model of evidence-based medicine did become the new standard. So one way you can look at it is where there is death there is hope, as a cohort of doctors who rubbished it moved into retirement and then death, the opposition disappeared. They were sort of optional. This may sound obvious but it is remarkable how many medical treatments of the past were conducted without that evidence.
Anupam Jena again:. This is one of the trickiest things about practicing medicine day-to-day. You make a diagnosis, and you write a prescription. What happens next? In many cases, you have no idea. The feedback loop in medicine is often very, very sloppy. Did the patient get better?
They never came back. But maybe they went to a different doctor. Or maybe they died? If they did get better, was it because of the medicine you prescribed? Or maybe they did fill the scrip but stopped taking it because they got an upset stomach. Or maybe they did take the medicine and they did get better but … maybe they would have gotten better without the medicine? Like I said, you have no idea. But with a well-constructed randomized controlled trial, you can get an idea.
Mapping Bad Medicine Laws
Vinay Prasad again:. It was conducted in the late s.
PRASAD: CAST was a study that — one of the things doctors were doing a lot for people after they had a heart attack was prescribing them an antiarrhythmic drug, that was supposed to keep those aberrant rhythms, those bad heart rhythms, at bay. That drug actually, in a carefully done randomized trial, turned out not to improve survival as we all had thought, but to worsen survival.
And that was a watershed moment, I think, where people realized that randomized trials can contradict even the best of what you believe. The only thing that really counts is what is the evidence you have that it works. The rise of randomized controlled trials led to a rise in what are called medical reversals. Vinay Prasad wrote the book on medical reversals, literally.
Bad Medicine, Part 1: The Story of 98.6 (Ep. 268)
It was that the benefits that we had postulated, turned out to be not true or not present. PRASAD: In the s we would recommend to postmenopausal women to start taking estrogen supplements, because we knew that women before they had menopause had lower rates of heart disease, and we thought that was because of a favorable effect of estrogen. PRASAD: So I think I started to get interested in this even when I was a student, and I saw that there were some practices that had been contradicted just in the recent past, but were still being done day in and day out in the hospital.
I mean, the example that comes to mind is the stenting for stable coronary angina. A stent is a little foldable metal tube that goes in a blocked coronary artery and the doctors spring it open, and it opens up the blockage. And stents are incredibly valuable for certain things. But stenting, like every other medical procedure, has something called indication drift where, yeah, it works great for a severe condition, but does it work just as good for a very mild condition?
And so over the years, doctors has used stenting for something called stable angina.
And stable angina is just that slow, incremental, narrowing of the arteries that happens to sadly all of us as we get older. But the bulk of stenting was this indication drift, and we thought it worked and made perfect sense. The rate of inappropriate stenting, Prasad says, is still way too high. Some common knee surgeries, for instance, where orthopedic surgeons take a tiny camera …. And in fact, people sort of felt a lot better. They had improved range of motion. And in fact, when you do it that way, you find that the entire procedure is a placebo effect.
So I would gather there are fairly weak incentives to doing the studies that would result in reversals — which also makes me wonder if there is a woeful undersupply of such studies, which means there probably would be even more reversals then there are. One of the things that we did in the course of our research was we took a decade worth of articles, in probably one of the most prestigious medical journals, the New England Journal of Medicine , and there was about maybe 1, articles that concern things that doctors do.
The second harm we say is this lag-time harm. We continue to do it for a few years after the reversal. And the third harm is loss of trust in the medical system. What are some solutions to a practice of medicine and medical research that results in fewer reversals? One is medical education. You know we have a medical education where for two years, students are trained in the basic science of the body. That the root, the basic science of medical school is evidence-based medicine. The next category is regulation. And I think many people in the community hope that products that are approved by the FDA are both safe and efficacious for what they do.
And advocates rightly said that we need a way to get drugs to patients faster, maybe even accepting a little bit more uncertainty. I think that was right. That have very good survival.
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