Will we ever learn? Probably not, because we are too confident: Heart failure drug doesn’t prevent heart failure, and sepsis drug doesn’t decrease mortality from sepsis.

 They all sound good at first. A decade later they don’t sound so good. Human recombinant activated protein C (HR APC; drotrecogin alfa; Xigris) addresses the pathophysiology of sepsis. It is low in sepsis and associated with death. Replacing it should work. So a randomized trial was done in 2001 (http://bit.ly/vQ0f5B) showing that it decreased […]

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EBM (the practice and the journal) takes a ribbing

A writer at the Boston Globe is annoyed by the terms “evidence-based medicine” (and “reality-based community” and “fact-based presidency,” among others that he calls verbal tics).  Surely these terms have become overused. But they have become overused because people want to base decisions in evidence.  But the reporter scoffs at the BMJ (and the journal […]

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Universal screening with computed tomography for lung cancer? Finally a randomized trial…but what to do??

Expert opinion and observational studies have favored lung cancer screening but trials (of plain xrays) have not shown benefit, until now. For years, many have been asking for a randomized trial. Now that the results of the (US) National Lung Screening Trial (NSLT) have been published, it reminds me of the admonition to “be careful […]

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Actually Accessible Evidence for Patients re: Prescription Drugs?

Pharmaceutical company advertisements (at least in the US) dutifully list a litany of side effects and other risks after presenting their benefits. Package inserts and many drug reference materials for health professionals do the same. The written lists are exhaustive and the print small, and in audiovisual ads the lists are read aloud faster than […]

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