6 ms·

There was a great book about Evidence Based Medicine, from a woman out of Oxford, I read a long while ago. Can't for the life of me remember the name, but Oxfor

There was a great book about Evidence Based Medicine, from a woman out of Oxford, I read a long while ago. Can't for the life of me remember the name, but Oxford does have a center for "Evidence Based Medicine," and the whole idea has been slowly coming back into fashion. Instead, all I can recommend is a collection of essays -- loosely -- related to the subject: Where's the Evidence?, Silverman --- On another note, someone who's gone down the pharmaceutical research rabbit hole and concluded a lot of it is "bunkum" (e.g. statins, anti-depressants, and so on), would do well to look into surgery next -- especially that of surgical implants. Some of worth looking into: joint replacements, joint and spinal fusions, angioplasties. Of note: spinal fusions were not brought about on any scientific or experimental bases, but on hunches from surgeons (damnable bunch). Many do result in a reduction in pain, but it does bring to question how much of it is simply "placebo." There were a few experiments in this realm of doing double blind (or single blind, it escapes me right now) studies on back surgeries, that showed evidence the placebo effect was involved. The simple act of being put under anaesthesia, and convinced one had gotten "treatment," resulted in reductions in pain for those who came in for spinal surgery. I do wish more research would be done into the placebo effect, and doctors would stop faffing about in self-righteousness (though having an air of expertise and authority does impact the placebo effect positively). And I don't mean in a "the placebo effect exists and is usable as a treatment" way, but in a "the placebo effect exists, and here is how it works in the body." That would be very interesting. Long ago I read a few papers on the placebo effect in regulating blood pressure via regulation of a certain chemical (it could have been a hormone like renin, but I can't recall). At the time, I thought the autonomic nervous system would be a good avenue to research to better figure this out (it would be a convenient explanation for how the placebo effect works: activating the nerves in the kidneys via the cross-talk from the central nervous system to excrete certain hormones). If it can affect the kidneys, what other bodily systems can it impact? The possibilities are not endless, but rather exciting. I believe the "placebo effect" is the reason chiropractors are so popular, in spite of there being no real physical evidence as to why their treatments help people.

LorenPechtel 3y ago
I do agree things should be studied but you have to be careful with it. Studies are big and expensive and things can be missed. Remember the big flap over hormone replacement therapy being shown harmful? Oops--all it really showed is what we knew all along, estrogen is risky for fat women.
- haldujai 3y ago
  > estrogen is risky for fat women I think what you meant to say is unopposed estrogen is risky for all women.
  - rgbgraph 3y ago
    It's a shame I have yet to see a microdose of testosterone included in HRT.
    - haldujai 3y ago
      What..? I don’t understand where this is coming from. Why on earth would we give testosterone to menopausal patients?
      - stubybubs 3y ago
        Estrogen/progesterone and testosterone are not exclusively female/male hormones. Testosterone may boost sex drive and increase muscle mass, as well as provide some psychological benefit in women. Estrogen is the most important regulator of bone health in both men and women. There are people with estrogen insensitivity syndrome, both men and women, and from all reports they are having an extremely uncool time: https://en.wikipedia.org/wiki/Estrogen_insensitivity_syndrome https://en.wikipedia.org/wiki/Estrogen_insensitivity_syndrom...
        haldujai 3y ago
        Yes but why on earth would testosterone be part of HRT for menopause? The point is to replace what’s missing and causing symptoms. Menopause =/= estrogen insensitivity.
importantbrian 3y ago
What makes you conclude that statins are "bunkum"? I don't know anything about anti-depressants or surgical implants, but I have gone down the rabbit hole on statins and at least as far as I can tell they do what they are generally claimed to do, are safe, and so if you are at high risk for hear disease you should probably be taking them.
- rgbgraph 3y ago
  In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health: LDL "large particle -- bad" cholesterol is not actually measured, but estimated. The current formula is: (total cholesterol - HDL - triglycerides)/5 which is liable to under-report true LDL levels. Estimation also has the drawback of being unable to tell how much of each "bad" particle is actually in your blood (chylomicrons vs VLDL vs LDL etc.) -- muddying your actual risk profile. Likewise, no LDL "content" tests are performed to measure how much cholesterol each LDL is actually carrying. So yes, statins will lower these numbers, but the methodology around these numbers is flawed, and only loosely correlated with cardiovascular health
  - haldujai 3y ago
    What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic This is just completely false, even from 2013 data[0] (which overestimates diabetes) but is better addressed in a subsequent review [1]. The side effects, if they do happen, are also self-limiting and stop with cessation or changing agents. > - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health ... and only loosely correlated with cardiovascular health See reference [1] and [2]. [0]https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-... [1]https://www.thelancet.com/article/S0140-6736(16)31357-5/fulltext https://www.thelancet.com/article/S0140-6736(16)31357-5/full... [2]https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fullt...
ramblenode 3y ago
> Of note: spinal fusions were not brought about on any scientific or experimental bases, but on hunches from surgeons (damnable bunch). Many do result in a reduction in pain, but it does bring to question how much of it is simply "placebo." You might be interested in Surgery, the Ultimate Placebo by orthopaedic surgeon Ian Harris.

LorenPechtel 3y ago

I do agree things should be studied but you have to be careful with it. Studies are big and expensive and things can be missed. Remember the big flap over hormone replacement therapy being shown harmful? Oops--all it really showed is what we knew all along, estrogen is risky for fat women.

haldujai 3y ago
> estrogen is risky for fat women I think what you meant to say is unopposed estrogen is risky for all women.
- rgbgraph 3y ago
  It's a shame I have yet to see a microdose of testosterone included in HRT.
  - haldujai 3y ago
    What..? I don’t understand where this is coming from. Why on earth would we give testosterone to menopausal patients?
    - stubybubs 3y ago
      Estrogen/progesterone and testosterone are not exclusively female/male hormones. Testosterone may boost sex drive and increase muscle mass, as well as provide some psychological benefit in women. Estrogen is the most important regulator of bone health in both men and women. There are people with estrogen insensitivity syndrome, both men and women, and from all reports they are having an extremely uncool time: https://en.wikipedia.org/wiki/Estrogen_insensitivity_syndrome https://en.wikipedia.org/wiki/Estrogen_insensitivity_syndrom...
      - haldujai 3y ago
        Yes but why on earth would testosterone be part of HRT for menopause? The point is to replace what’s missing and causing symptoms. Menopause =/= estrogen insensitivity.

importantbrian 3y ago

What makes you conclude that statins are "bunkum"? I don't know anything about anti-depressants or surgical implants, but I have gone down the rabbit hole on statins and at least as far as I can tell they do what they are generally claimed to do, are safe, and so if you are at high risk for hear disease you should probably be taking them.

rgbgraph 3y ago
In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health: LDL "large particle -- bad" cholesterol is not actually measured, but estimated. The current formula is: (total cholesterol - HDL - triglycerides)/5 which is liable to under-report true LDL levels. Estimation also has the drawback of being unable to tell how much of each "bad" particle is actually in your blood (chylomicrons vs VLDL vs LDL etc.) -- muddying your actual risk profile. Likewise, no LDL "content" tests are performed to measure how much cholesterol each LDL is actually carrying. So yes, statins will lower these numbers, but the methodology around these numbers is flawed, and only loosely correlated with cardiovascular health
- haldujai 3y ago
  What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic This is just completely false, even from 2013 data[0] (which overestimates diabetes) but is better addressed in a subsequent review [1]. The side effects, if they do happen, are also self-limiting and stop with cessation or changing agents. > - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health ... and only loosely correlated with cardiovascular health See reference [1] and [2]. [0]https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-... [1]https://www.thelancet.com/article/S0140-6736(16)31357-5/fulltext https://www.thelancet.com/article/S0140-6736(16)31357-5/full... [2]https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fullt...

ramblenode 3y ago

> Of note: spinal fusions were not brought about on any scientific or experimental bases, but on hunches from surgeons (damnable bunch). Many do result in a reduction in pain, but it does bring to question how much of it is simply "placebo." You might be interested in Surgery, the Ultimate Placebo by orthopaedic surgeon Ian Harris.