A Study a Day Keeps the Doctor Away
(Page 3 of 3)
Utne Reader September / October 2007
Leyla Kokmen
Proponents respond by stressing that the movement isn't out to force doctors to only look at randomized controlled trials--which aren't always an option when it comes to testing certain treatments--but rather to encourage them to examine the available evidence and use it to make the best judgment possible.
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'Some people act like having evidence is a tyranny that tells you what you've got to do,' says Floyd J. Fowler Jr., president of the Boston-based Foundation for Informed Medical Decision Making. 'Common sense and clinical judgment are not always right. You don't want to forget about thoughtful, informed opinion. But thoughtful, informed opinion buttressed by evidence is better.'
The reality is that most medicine doesn't have strong evidence proving categorically that one treatment is better than another. Having more evidence and better evidence is simply a starting point to help us understand what's likely to work and what isn't.
'From a patient point of view, it can only be good to have evidence about effects of treatments,' Fowler says. 'There is no downside.'
Consider the mastectomy example from the Dartmouth atlas, which found that 2 women per 1,000 female Medicare recipients have mastectomies in South Dakota, compared to 0.3 per 1,000 in Vermont--despite the fact that that there are few differences in long-term outcomes for women who have mastectomies and those who have less invasive lumpectomies followed by radiation.
But when women are diagnosed with breast cancer, some may choose the more radical mastectomy. They may want to get rid of the breast to minimize any chance of recurrence. Others may want nothing more than to save the breast and opt for the lumpectomy.
'Folks just have different perspectives,' Fowler says. What's important is that people make decisions that factor in both the potential success of a treatment and the possible side effects or loss of quality of life. And that means learning to ask about the evidence. 'Patients,' Fowler says, 'shouldn't delegate important decisions to doctors without being informed.'
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