E-drug: Mefenamic acid and evidence-based medicine
----------------------------------------------------------------
Sam Wagner makes several important points in his very useful
comments.
The reason we don't accept "real life" experience as "evidence" is
precisely because it is not systematic and reproducible. We need in
clinical studies to have a certainty that the effects we are observing are
due to the specific action we have taken. In the situation that Sam
describes this is not possible because of many factors like external
influences, observer bias, uncertain end points, etc. No matter how
much subjective results are obtained, they can never be converted into
objective results.
The next point he makes is a valid one about the ratio of risk and
benefit. The perceived risk of giving these medicines is low compared to
the apparent benefits accrued. If this wasn't the case, the medicines
would not be prescribed or administered. It must be stressed that these
are based on perceptions. It may well be that the actual risks are low -
present but low in as much as they are not often observed. However we
also know that the actual benefits are also low. We are interested in the
rational use of medicines and must continue to preach this message.
Resources used in the management of patients in the way described may
deny the use of resources in other areas of health care or treatment.
These opportunity costs when included in the analysis may make it more
imperative that we do not treat patients in this way.
Tim Dodd
Director of Pharmacy
Shaukat Khanum Memorial Cancer Hospital
Lahore, Pakistan
timdodd@brain.net.pk
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.