therapeutics

therapeutics - risks and benefits of therapies, medications, drugs, etc

introduction

  • before we prescribe a treatment, or as a patient, accept a treatment, we should have a reasonable understanding of the expected benefits and the potential risks of that treatment.
  • over the centuries, many treatments have been passed on as useful from anecdotal evidence alone, and often based on seemingly plausible explanations as to why they should be useful.
  • logical anecdotes may be very accurate for some things such as:
    • benefits of straightening most broken bones and immobilising until adequately healed
    • wearing a parachute if one is going to be silly enough to jump out of a plane
  • Anecdotes and plausible theories may give very wrong risk benefit analyses indeed
    • Who would have thought giving oxygen to heart attack patients would make them worse?
    • There are countless treatments that have been discredited over the centuries, although many did work, they have been replaced by more effective treatments while others were shown to have more risks than benefits
  • The only real way through this quagmire of confusion is to do properly designed, well run trials of adequate power to prove or disprove these therapies - hence evidence based medicine (EBM)
  • even when using such trials, we need to make sure the trials use similar types of patients and genetics, and standardized form of therapy
  • thankfully most of our medications regulated by western governments are relatively standardized in terms of ingredients and their potencies and amounts which allows us to better apply the studies to these.
  • this critical aspect does NOT necessarily apply to less regulated substances such as over the counter herbal or “natural” medicines which, just like illegally acquired illicit substances, may vary significantly in terms of:
    • potency and amount of ingredients due to lack of standardisation
    • they may have been derived from the wrong plant or wrong part of the plant
    • they may be contaminated with bacteria, fungi, pesticides, and usually have multiple additives
    • they may have been adulterated with drugs such as steroids, analgesics, anticonvulsants
    • the lack of critical evidence submissions often allow for false marketing claims
    • the risks are not made clear - for example half of all fatal cases of drug -induced hepatitis in China is due to traditional Chinese medicines, while many herbs have very important drug interactions with chemotherapy, warfarin, etc.
  • recent studies have at long last examined homeopathy therapies and not surprisingly, have shown that these therapies do not have any added benefit over placebo.
  • another recent study showed that there was no benefit of arthroscopic orthopaedic knee surgery in some patients with chronic knee pain.
  • these studies help us to stop wasting money and stop exposing ourselves and our patients to useless or dangerous therapies.
  • they are critical to forming solid logical reasoning and risk management.
  • unfortunately many people do not have the capacity for logical reasoning and instead find solace in mystical thinking or wishful thinking or thinking dominated by unreasonable risk assessment and emotive fears. Worse still are the legion of predators in the world who aim to profit from this through pseudo-scientific or other marketing ploys.
    • Hence we have a new generation of parents who oppose vaccination when the benefits clearly far outweigh the risks.
therapeutics.txt · Last modified: 2014/04/13 16:31 (external edit)