By: kidmugsy

kidmugsy — Thu, 25 Oct 2012 10:40:00 +0000

Yet I routinely see people urging me to attain a particular BMI without mentioning my age, my sex, or my race. Stratified medicine would seem to be the opposite of what the Medicalbullying Tendency seeks to achieve.

By: Huw Llewelyn

Huw Llewelyn — Wed, 17 Oct 2012 21:59:00 +0000

This is indeed very exciting. However, my understanding of medical progress
is that it progressively makes medicine more stratified, personalised and
precise. For example, at one time we
diagnosed ‘dropsy’ and prescribed digitalis (NNT about 100 perhaps). We then ‘stratified’ ‘dropsy’ by working out in a more precise way that it was those with ‘dropsy’ AND a rapid irregularly irregular
pulse who respond best (NNT 1 to 2 perhaps). We called it ‘atrial fibrillation’! We now have a choice of treatments e.g. beta-blockers,
cardio-version, warfarin, asprin, etc that will suit some patients more than
others depending on other factors, thus ‘personalising’ the medicine too.

The Appendix of the Oxford Handbook of Clinical Diagnosis explains
to students how all this can be done in a logical and systematic way by using
symptoms, signs and tests (which includes genetic information). It also explains why using two standard
deviations to select patients for treatment is inappropriate, using the albumin
excretion rate as an example to show how cut-off points can be placed in a
pragmatic way. So, we must also see these developments in the context of the
history of medicine.

Comments on: Richard Smith: Stratified, personalised, or precision medicine

By: kidmugsy

By: Huw Llewelyn