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ethics

Proof of equipoise

12 Nov, 12 | by Bob Phillips

In order to test a new treatment, in a standard randomised controlled trial, we are ethically assumed to have ‘equipoise’: an honest uncertainty at the same chance of a patient being allocated to the new or old treatment. But, I hear you scoff, how can any investigator put themselves through the hell of ethical administration forms, R&D offices and the potential of an infestation of drug safety investigators without being pretty convinced that the new way is better?

Well, in true evidence-based self-analytical fashion, a highly respected gang of investigators determined to see if equipoise had been met [1]. They undertook a systematic review of cohorts of publicly funded studies (not pharma ones) and assessed if the new treatment was better than the old one or placebo, whichever was the comparator. They found that only slightly less than half the time the new treatment was no better than the comparator, and the new therapy was only very rarely an major advantage.

How can we use this information? Well, I think we can use it every time we face a patient and family with the option to enter a large, non-pharma, RCT. We can honestly say that, looking back, we’re right with the new treatment only half the time and that trials are truly the only accurate way of testing treatments fairly.

Reference:

New treatments compared to established treatments in randomized trials. Benjamin Djulbegovic et al. Cochrane Library, DOI: 10.1002/14651858.MR000024.pub3

 

Secrets and lies. Truth and beauty.

30 Jun, 11 | by Bob Phillips

… and other Bohemian aphorisms …

There is a quite brilliant paper from the under-advertised PLoS One which shows how, in the are of incubation periods for respiratory disease, Truth By Citation is quite strikingly different than the reality of the evidence. The networks of citations demonstrate how repetition, sometime but not always with a citation, leads to a ‘truth’ emerging which does not reflect the real picture of the evidence.

Truth, beauty, and absinthe

This paper joins a similar mass of information which demonstrates how information about prognostic biomarkers are dominated by the few studies which show remarkably strong associations, and rarely reference the systematic reviews that place the studies in context.
And there is are still the classic example of sudden infant death and sleeping position. more…

Average is a human rights abuse

7 Feb, 10 | by Bob Phillips

JME CoverThis article in the Journal of Medical Ethics was directed at Archi from the Editor of E&P, and has got me all thoughtful about how a simple understanding of statistics is essential to everyone, even those working with the judiciary.

The team writing this study reviewed the decisions of forensic physicians who were determining if the age of adolescents involved in French judicial proceedings for criminal or asylum purposes, looking to see if their decisions were supported by the best quality evidence. more…

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