Life is full of little ironies, one of them in my case being that I have more time than ever before, now that I have retired from practice, to read medical journals. I find the experience a little unnerving.
In the old days I glanced through the journals and naïvely supposed that the summaries of the scientific papers provided for busy doctors represented the content of those papers more or less accurately and, what’s perhaps more important, that the conclusions followed from the evidence. I have found, on reading the journals more carefully, that this is often not so: that the conclusions do not follow from the evidence or are presented in such a way as to be misleading.
I am not a thoroughgoing skeptic about modern medicine, and like almost everyone else I would take myself off to a doctor in the event of illness. If it were not for modern medicine, or comparatively modern medicine, I would have been dead a long time ago. Nevertheless, it is not reassuring that so much of what doctors do, and what I did myself, is less than scientifically sound or justified, and some of it is downright harmful. Defy Your Doctor and B... Best Price: $10.38 Buy New $28.00 (as of 01:05 EST - Details)
Here, for example, is a little item from the back of a recent edition of the British Medical Journal. It comes from a column called “Minerva,” which supplies very short summaries of interesting papers in other medical journals. It reads as follows:
If patients knew how little the drugs they were taking were likely to benefit them, would they bother to carry on? In type 2 diabetes, tight blood pressure control is probably only of value above a certain threshold of cardiovascular risk, as shown by the ADVANCE trial, among others. But an analysis of the ADVANCE data … shows that even if you select the patients at the highest risk, you would need to treat 200 for five years to prevent one adverse event.
I should perhaps point out that controlled trials in medical research are often given acronyms or pseudo-acronyms, in this case ADVANCE standing, almost, for Action in Diabetes and Vascular Disease. And the event referred to in the above passage is a heart attack or stroke.