Will they ever mesh? Take this example:
In order to advise your patient on the magnitude of benefit of the proposed treatment you look for, or calculate the absolute risk reduction (ARR) for the proposed treatment as well as the absolute risk increase (ARI) for bleeding. In order to translate this into language the patient can understand you then, from the absolute risk reduction for DVT and the absolute risk increase for bleeding, calculate the number needed to treat (NNT) and number needed to harm (NNH) respectively.
Unless you want to include a basic statistics course with every patient conversation, fully incorporating the evidence into every patient encounter is not going to happen.
Related posts:
- Shared decision making
- Is evidence-based medicine desirable?
- Shared decision making
- Is evidence-based medicine appropriate for the elderly?
- Why patients will reject evidence-based medicine
- Marc Siegel apparently doesn’t care about evidence-based medicine
- Does evidence-based medicine raise costs?
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Which leaves out the whole problem of just how flawed many of these studies are. Cox-2 inhibitor trials not controlling for the lack of cox-1 inhibition as a possible mechanism of increased heart attack risk. Glucosamine/chondroitin/MSM studies done on people with bone on bone contact. Etc.
Using numbers like ARR, RRR, NNT, NNH, and all that is especially problematic when we try to pretend that the numbers themselves have any sort of validity.
In something as complex as the human body, you can try to take an overall snapshot with a study but it’s beyond our power to say ‘this many will be saved and this many people will be hurt’.
I am not talking about statistical power but limits of study design.
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