tag:blogger.com,1999:blog-5687347459208158501.post1442267339161269544..comments2024-03-29T03:19:09.227-04:00Comments on The Philosopher's Stone: FASCINATING STUFF I NEVER KNEWRobert Paul Wolffhttp://www.blogger.com/profile/11970360952872431856noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-5687347459208158501.post-48375804576531541392015-01-28T20:25:37.733-05:002015-01-28T20:25:37.733-05:00There are countless regular procedures and medicin...<i>There are countless regular procedures and medicines that have no more effect than leeches on average. </i><br /><br />Many years ago, I worked in a hospital in-patient pharmacy as a tech. We actually had leaches that we used from time to time, and they worked quite well for the purposes we used them for - sucking blood. If, say, you have your ear cut off, it's important to keep blood flowing to the ear after it's sown back on. But, that's not super easy on its own. If, however, you stick a few leaches on the ear, they will keep blood flowing to it (and them), because of their sucking and their anti-coagulation saliva (or whatever comes out of a leach mouth.) They are also good for more cosmetic uses, such as making a fresh bruise go away. I expect they are not good for most other things. But for these things, they seemed to be quite useful. Matthttps://www.blogger.com/profile/01446428606119200980noreply@blogger.comtag:blogger.com,1999:blog-5687347459208158501.post-47503013841282823082015-01-26T15:09:41.108-05:002015-01-26T15:09:41.108-05:00Arghh!!!
Paragraph 3 should end with\
"and ...Arghh!!!<br /><br />Paragraph 3 should end with\<br /><br />"and many have all the benefits washed out with all the costs (antibiotic treatment for minor infections, beta-blockers for heart attacks, etc.)"Jim Westrichhttps://www.blogger.com/profile/11523640492416820740noreply@blogger.comtag:blogger.com,1999:blog-5687347459208158501.post-72828646514026801332015-01-26T15:07:19.318-05:002015-01-26T15:07:19.318-05:00This type of evidence based decision making is rea...This type of evidence based decision making is really helpful. One of the positive aspects of the Affordable Care Act was the attempt to add more evidence to medicine. <br /><br />There are countless regular procedures and medicines that have no more effect than leeches on average. Some times that is the effect of "averages" (many orthopedic surgeries have no average effect but everyone goes to Lake Woebegone Surgical Associates), some of these are placebo effects (cough syrup), and many have all the benefits <br /><br />I am afraid that the prophylactic use of low-dose aspirin is pretty to close to the last scenario. You mention that it has a NNT of 2000 for heart attack (that is actually better for any heart problem--1 in 1667) but failed to mention the risks of major bleeding issues (1 in 3333). <br /><br />When you let doctor's decide they choose a lot more care than people would if given the information in an understandable way. People, even people who define themselves as "risk-loving", generally avoid ANY treatment/drug/procedure with a possible benefit so low as 1 in 2000 particularly when they see the risk is (admittedly low) 1 in 3333.<br /><br />I was involved with a project where many people avoided 3 in 10 benefits when there was 1 in 50 harm. Not everyone, of course, but this was for a decision where the doctor would routinely go ahead after saying there are "some" not numerated risks.<br /><br />That is why those dot diagrams are so important (not everyone thinks in numbers) and helpful. <br />It is just that they are not so widely used. In general, getting patients more involved goes under the rubric of "patient-centered decision making" but there is a wide difference to actual quality of the material helping patients make decisions.<br /><br />P.S. I know David Auerbach was joking but yes some people get hit by busses but generally that would be randomized across those taking the aspirin and those not. I would argue that those taking aspirin are marginally more likely to get hit by said bus because they could decide to cross roads while taking said aspirin.Jim Westrichhttps://www.blogger.com/profile/11523640492416820740noreply@blogger.comtag:blogger.com,1999:blog-5687347459208158501.post-69600637100038904662015-01-26T14:01:19.712-05:002015-01-26T14:01:19.712-05:00Not sure how they do those stats. It might be that...Not sure how they do those stats. It might be that some of those 1,995.4 who wouldn't get a heart attack wouldn't because they got hit by a bus first.David Auerbachhttps://www.blogger.com/profile/15612242467208247588noreply@blogger.com