tag:blogger.com,1999:blog-1732132352927731247.post1683208701233993275..comments2024-03-16T00:27:31.848-07:00Comments on Hooked: Ethics, Medicine, and Pharma: The Sources of Uncertainty in MedicineHoward Brodyhttp://www.blogger.com/profile/00599587504924835039noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1732132352927731247.post-10980896804585119802011-05-27T08:56:46.235-07:002011-05-27T08:56:46.235-07:00Apologies for the long comment.
Extrapolating fro...Apologies for the long comment.<br /><br />Extrapolating from the group to the individual is extremely difficult. It requires the treating physician to evaluate the conditional probabilities of benefit and harm based on conditions that differ from those tested.<br /><br />Conditional probabilities are extremely difficult to calculate and our intuition about them can be wildly off base.<br /><br />Here is an example (adapted from one in The Drunkard's Walk).<br />If John and Mary have two children what is the probability that both are girls? Answer 1/4.<br /><br />Now we add a condition: The older child is a girl. What is the probability that both are girls? Answer 1/2.<br /><br />Now we change the condition slightly: One of the children is a girl. What is the probability that both are girls? Answer 1/3.<br /><br />Now we add a seemingly irrelevant condition. One of the children is a girl with curly hair. What is the probability that both are girls? Answer: It depends on the proportion of curly-haired girls in the population. If John and Mary are in Nairobi the answer will be about 1/3. If John and Mary are in Seoul the answer will be about 1/2. Note that in a medical situation would be a large difference; 0.3 to 0.5.<br /><br />Even in this simple example the answers are completely counterintuitive. Who could imagine that the curly hair condition could change the probability of both children being girls.<br /><br />Now imagine trying to extrapolate from research data in which the subjects met a range of conditions, but the patient we are trying to treat has several other conditions, such as chronic medical illnesses, additional medications for those medical illnesses and different life circumstances. It is mathematically intractable.<br /><br />Faced with no logical way of finding the correct answer we pick a choice based on what we think and feel we are expected to do. And this is based on who we are listening to, what they are doing, what they are telling us to do, ... . Which is why the marketing and drug reps being schmoozy, and the KOLs etc are so influential.Joseph P Arpaia, MDnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-67509137979965273272011-05-27T02:46:09.364-07:002011-05-27T02:46:09.364-07:00This type of the articles usually comes in many ar...This type of the articles usually comes in many articles and these things which you have mentioned are really true. All the physicians must also think about this. Then there would be more health care.Alex Wonghttp://www.gotvape.com/noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-69906193262271272112011-05-25T16:30:54.773-07:002011-05-25T16:30:54.773-07:00Actually, the STAR*D trial is not a 'good'...Actually, the STAR*D trial is not a 'good' example. Dr. Nardo and others have done extensive analyses of the problems with the STAR*D trial. Start reading here<br />http://1boringoldman.com/index.php/2011/04/03/a-thirty-five-million-dollar-misunderstanding/ and search his blog on the term STAR*D.Bernard Carrollhttps://www.blogger.com/profile/16203083806436919715noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-40417558433563822632011-05-25T14:03:38.746-07:002011-05-25T14:03:38.746-07:00A good example of psychiatric comparative effectiv...A good example of psychiatric comparative effectiveness is the STAR*D trial (funded by NIMH). Pharma donated drugs: Citalopram, Sertraline, Bupropion, Venlafaxine, Buspirone, Mirtazapine, Triiodothyronine, Nortriptyline, Tranylcypromine and Lithium without input into design, data collection, analysis,or publication of the study.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-90925641590068746652011-05-23T10:11:35.457-07:002011-05-23T10:11:35.457-07:00Why is there so much efficacy data and so little e...Why is there so much efficacy data and so little effectiveness data? As you say, it is because pharmaceutical corporations now control the clinical research agenda. Nowhere is this more evident than in psychiatry. In the major push over recent years to creep the indication of nonresponding (and nonpsychotic!) depression for the atypical antipsychotic drugs, there are no data comparing these drugs head to head with tried and true off-patent lithium, even though it appears lithium is considerably more useful.<br /><br />What’s scandalous is that the question of comparing risperidone or aripiprazole or olanzapine with lithium is simply off the table, and that the FDA allows this charade to continue. As for the enabling KOLs, well, you decide.Bernard Carrollhttps://www.blogger.com/profile/16203083806436919715noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-42509005269128566132011-05-23T07:51:19.286-07:002011-05-23T07:51:19.286-07:00I have heard over and over again (from doctors) t...I have heard over and over again (from doctors) that patients are the ones demanding tests and meds but my own experience is completely different! My doctors are the ones pushing for tests and meds when I am completely asymptomatic. Obviously there is a disconnect somewhere....JPBnoreply@blogger.com