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Knowing In Medicine
Or perhaps a more apt title would be “Not Knowing that we Don’t Know in Medicine”. A colleague and I gave a lecture last week on EBM in the context of how do we know what to do in medicine. We pointed...
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Affect Heuristic,COI, or Lack of Knowledge? Why Do Cardiologists Overestimate...
A recent study in JAMA Internal Medicine by Goff and colleagues made me wonder if the Cardiologists studied are uninformed of the limited benefits of stenting (PCI) for chronic stable angina, do they...
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Why do clinicians continue medications with questionable benefit in advanced...
A recent study in JAMA Internal Medicine estimated the prevalence of medications with questionable benefit being used by nursing home residents with advanced dementia. This is an important question...
View ArticleOvercoming Probability Inflation
Benjamin Roman, MD, MSPH wrote a wonderful piece in this week’s New England Journal of Medicine. It might not get read much because it is listed way down the table of contents but I think it is more...
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How to calculate patient-specific estimates of benefit and harm from a RCT
One of the more challenging concepts for students is how to apply information from a study to an individual patient. Students have been taught how to calculate a number needed to treat (NNT) but that...
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Do lipid guidelines need to change just because there is a new, expensive...
Shrank and colleagues published a viewpoint online today positing that lipid guidelines should return to LDL based targets. I think they are wrong. The use two studies to support their assertion. First...
View ArticleIs tinzaparin better than warfarin in patients with VTE and cancer or not?
The CATCH trail results were published this week in JAMA. Read the abstract is below. Do you think this drug is useful for venous thromboembolism (VTE) treatment? Importance Low-molecular-weight...
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What to do when evidence has validity issues?
I often wonder how different clinicians (and EBM gurus) approach the dilemma of critically appraising an article only to find that it has a flaw(s). For example, a common flaw is lack of concealed...
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SPRINT Trial Misunderstood and Misapplied- Part 1 (Not Knowing Who’s in the...
The SPRINT Trial was an important trial for the evidence base in hypertension. Previous studies had shown that intensive BP lowering in patients with type 2 diabetes (<120 vs <140 mm Hg) and in...
View ArticleI wonder how much EBM is really practiced out there
WARNING: a lot of cynicism in this post. I have been revamping my EBM course that I teach at the medical school. As I’ve been doing this I realize we (the collective EBM teachers of the world) teach...
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