Double Standard

Double Standard

Medical trials are complicated. There is not only the treatment being evaluated, but there is the complex, dare I say it, biopsychosocial components of the interaction that can make efficacy difficult to determine. Interactions between the patient and the medical-industrial complex can all sorts of benefits and detriments even when there is no change in the underlying physiology.

People will usually perceive themselves as improved after a positive intervention with a provider. At its core it is probably no different than when a parent kisses an injury to make it better.

It is in part why we do placebo controlled clinical trials. They are not treatment vrs placebo/sham treatment. They are the entirety of the medical experience plus treatment vrs the entirety of the medical experience plus placebo/sham.

And if the entirety of the medical experience plus treatment is no different than the entirety of the medical experience plus placebo/sham, we say that the treatment has no efficacy. It is why we no longer perform internal mammary artery ligation for angina. When compared to sham surgery it was no better, so was abandoned.

There was a recent sham surgery trial published in the NEJM that demonstrated

the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear.

Note the bold. If a treatment is equal to sham/placebo is should be abandoned.

Except for acupuncture (and other pseudo-medicines). When real acupuncture has the same results as sham acupuncture, the conclusion?Use acupuncture.

We found that patients with early-stage, hormone receptor-positive breast cancer taking an aromatase inhibitor showed significant improvement in some symptoms, especially hot flashes, after eight weekly treatments with real acupuncture or sham acupuncture,” Bao said. “If we really want to find something that will help patients, acupuncture is a reasonable alternative to drug therapy, which can produce its own set of side effects.

The misinterpretation of a medical study like this Drives. Me. Nuts. It seems to be an increasingly common way to spin a negative study for pseudo-medicines, especially for acupuncture.

On the other hand, I guess we should continue partial medial meniscectomy and bring back internal mammary artery ligation, right?

Dangerous Liasons: chiropractors and drugs
Points of Interest: 2/07/2014

Related Posts