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

Comment: Testicular self-examination

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These were comments to the article “Monday’s medical myth: testicular self-examination is a waste of time” by Mark Frydenberg, published in The Conversation.

Thank you for your opinion, Prof Frydenberg, but can this really be considered a “myth”? I appreciate that your affiliated organisation Andrology Australia recommends routine testicular self-examination, but this is not the position of the Royal Australian College of General Practitioners, nor the US Preventive Services Task Force.

If I’ve read your article correctly, your rationale is that routine self-examination will lead to earlier detection and better survival, and that it has no harm. These claims need to be examined carefully. As has been pointed out already, there is no evidence that routine screening improves survival, and indeed, it is unlikely that any screening procedure will. This is not only because testicular cancer is relatively uncommon but because treatments are so effective at all testicular cancer stages. Continue reading

Comment: EBM vs CAM

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Comment to the article, “Evidence-based medicine v alternative therapies: moving beyond virulence” by Kerreen Reiger, published in The Conversation:

Health claims are empiric claims. They can be tested using empiric methods. Scientific frameworks allow use to gauge the reliability of evidence. For example, the narrative claim from an individual that they were helped by chiropractic is much less useful for predicting whether chiropractic will help another individual in the future compared with evidence from a clinical trial.

This is not profound.

That medical consultations need to take into account patient values and clinical expertise is unquestioned. It is remarkable that proponents of CAM believe that non-CAM practitioners believe otherwise. All arguments that claim that the supporters of evidence-based medicine (EBM) do not hold both as important in clinical decision making should be denounced for what they are: nonsense.

The genesis of EBM is the recognition that respecting patient values, and having clinical expertise is NOT ENOUGH. The additional “special sauce” of EBM is that clinical decisions need also be informed by the best available scientific evidence. We should be mindful of the powerful cognitive biases that operate in clinical interactions, both in patients and clinicians. We should recognise that individual beliefs about health, illness and disease is not the same as empiric reality.

Comment: Response to “Tarring complementary medicine is anti-choice”

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The following is a comment to an opinion piece, “Tarring complementary medicine is anti-choice” written by Kerryn Phelps in Medical Observer.  My comments were published online on 21 March 2012.

I concur with some of the statements in the comments and feel I must support my colleagues who are members of the Friends of Science in Medicine (FSM).

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Comment: Homoeopathy, ethics and controversy

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Comment to the article “Homeopathy isn’t unethical, it’s just controversial” by Jon Wardle, published in The Conversation.

To be frank, it is really quite simple. Homoeopathy isn’t “controversial”. It does not work. There is no good empiric evidence that it does, plenty of empiric evidence that it doesn’t, and entirely lacks scientific plausibility.

There is a misunderstanding of evidence-based medicine that supportive evidence of an intervention study in an RCT is equivalent to evidence of effectiveness. This is not true. If you do 20 perfectly run RCTs on inert substances using the standard for statistic significance at P < 0.05, you would expect that 1 study would demonstrate a statistically significant result. The point is, RCTs are only really valid when taken in the context of the pre-text probability of the intervention. As has been mentioned many times before, for homoeopathy (the specific intervention) to be true, we must overturn our knowledge of physics and chemistry. Continue reading

Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base?

Tam CWM. Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base? [Letter] Med J Aust 2011; 195(11): 660-661

This was a Letter to the Editor published in the Medical Journal of Australia.

DOI: 10.5694/mja11.11333

The article is in PDF format and hosted by Google Drive.

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