Comment: Prof Ken Harvey’s resignation from La Trobe University

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The following is an amalgamation of a couple of comments written on the Paging Dr forum board.  This was in relation to the high profile and controversial resignation of Prof Ken Harvey from La Trobe University, following the announcement of the $15 million deal between Swisse and the university.

It is one thing to fund research into CAM. For this to be scientific, one must have a scientifically sound a priori reason why you are doing the human research in the first place.

It is quite another thing for a single manufacturer to fund a research institute that will effectively be set up to investigate its products that it already markets to the general public.

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Comment: GP co-payments? Don’t save on primary care

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The following is a comment to the online article, “GP co-payments? Don’t save on primary care” written by GP blogger, Dr Edwin Kruys.

Dear Edwin,

Great article. I agree with your premise.

Regarding individuals valuing the services they receive from the GP more with co-payment, we should recognise that this is a complex question. We should recognise that many GPs already privately bill. Continue reading

Comment: Empirical evidence, not eminence, and certainly not dogma

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The following is a comment/letter to the editor to the online article, “Some catalysts for debate on statins“, published in Medical Observer.  This article covered two somewhat opposing perspectives by Prof Kerryn Phelps, and Prof James Tatoulis to the controversial ABC Catalyst program on the role of lipids and statins on health.  The shorter online response was published on 20 November 2013, and an expanded version was published in the final volume of Medical Observer in 2013.

Empirical evidence, not eminence, and certainly not dogma.

What we know about empirical evidence is that conjectures and suppositions extrapolated from cherry-picked data points, pathophysiological rationale, or anecdote, are often misleading and not “useful” – insofar as being able to make correct predictions of the future.

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Comment: Scaphoid fractures. Thumbing through the research

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The following is a comment to the online article “Scaphoid fractures. Thumbing through the research“, written by Dr Robin Park on the FOAM4GP website.  This was a very readable summary of some of the evidence behind the management of scaphoid fracture assessment in the general practice context.

Dear Rob,

Another fantastic post and summary!

Before I give my 2c on this clinical scenario, I like to reflect on the Dave Sackett vision of EBM – that it is the combination of best external evidence, patient values and expectations, and clinical expertise. The research evidence (of which the majority in this scenario has not been in the primary care setting) needs to be applied in a critical manner, appropriate to the context and setting in which care is provided. Continue reading

Comment: To statin or not to statin?

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The following is a comment to the online article, “To Statin or not to Statin? – That is the question” by Dr Robin Park.  This article is a very readable summary of a number of practical questions about statins for GPs.

Great summary Rob!

A few comments… The evidence for the benefit of LFT and CK monitoring for statins is poor, and the rationale for doing so is questionable in light of the accumulated safety data for statins. An argument can perhaps be made for baseline LFT (even in otherwise fit and well people), but the utility of a baseline CK is rather low in someone not at high risk of myopathy. Stopping a statin in someone who is at mod/high CVD risk, due to an asymptomatic rise in CK, probably does more harm than good. Continue reading

Comment: Viewing Catalyst’s cholesterol programs through the sceptometer

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This was a comment to the online article, “Viewing Catalyst’s cholesterol programs through the sceptometer“, written by Dr Justin Coleman, published on The Conversation on 4 November 2013.  This was an interesting perspective offered by a clinical general practitioner following the rather problematic Catalyst program on cholesterol and statins.

Great article Justin!

I agree with most of your points, but as per Prof Clifton’s comment, the accumulated evidence has moved on somewhat from the meta-analysis from 2010. Newer systematic reviews and meta-analyses on the question of the effectiveness of statins in primary prevention have generally found some mortality and cardiovascular benefit. For instance, in a short piece for Medical Observer published last Friday, I looked at a meta-analysis from 2011 specifically in patients at low absolute CVD risk: http://vitualis.com/?p=505 Effectively, the magnitude of the effect is about the same as that found in the Ray et al. (2010) meta-analysis, but with narrower confidence intervals that no longer includes no-effect. Prof Clifton already quotes the 2013 update of the Cochrane systematic review which demonstrates a similar result. Continue reading