John Gee was kind enough to forward this to me:

This is a good look at the science, and sort of echoes what I’ve been talking about on this blog.

It discusses a reanalysis of the French data (which, when you include all the patients, makes it far less compelling that it seems at first glance).

The author, a drug researcher, makes an excellent point:

It’s no wonder that this work has set off so many arguments: statistically, it’s like a funhouse mirror. Here, though, is where some of the folks pinging me on Twitter and sending me emails tend to get more worked up, especially to that point about anecdotal data. I can see where they’re coming from: if you haven’t done this stuff, you can look at a report of people responding to such a treatment and figure that the answer is here – right here, and anyone who doesn’t see it must have some ulterior motives in ignoring what’s in front of their face. But that’s not how it works.

It’s weird and startling, though, if you haven’t had the opportunity to go back through clinical research (and even patient treatment) and seen how many things looked like they worked and really didn’t. It happens again and again. Alzheimer’s drugs, obesity drugs, cardiovascular drugs, osteoporosis drugs: over and over there have been what looked like positive results that evaporated on closer inspection. After you’ve experienced this a few times, you take the lesson to heart that the only way to be sure about these things is to run sufficiently powered controlled trials. No short cuts, no gut feelings – just data.

The hardest position to be in (something we confront in family medicine all the time) is when the data we need just isn’t there, or doesn’t exist.

The best rule of thumb is the old medical maxim (one of the few good things we got out of classical medicine)–Primum non nocere.

“Above all or first of all, do no harm.”

Doing nothing instead of something is hard. But it’s the right choice surprisingly often.

Anyway, I encourage you to check out the article. The guy knows way more than I do.

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