Health

We don’t know whether most medical treatments work, and we know even less about whether they cause harm

According to a study, only one in 20 medical treatments has high-quality evidence to support its benefits. recent study. The study also revealed that harms of treatments were measured three times as often (a third) as benefits.

Patients and doctors—and anyone who pays for them—need to know that medical treatments are safe and effective, but it’s an open secretIn medicine, not all treatments are safe and effective. Antiarrhythmic drugs, for example, were commonly prescribed in the belief they would reduce heart attacks deaths. However, a clinical trial revealed that they actually reduced heart attack deaths. actually increased the risk of death.

Another example: Babies should be placed on their stomachs until they are less likely to choke. Large studies later found that stomach sleeping increases the chance of an infant choking. sudden infant death syndrome.

How big is this problem?

In the early 2000s researchers estimated that between quarterYou can also find out more about a halfEvidence of high quality supports the validity of treatments. These estimates are out of date and use old methods (such researcher opinion) to determine if the evidence is high-quality or not. A more exact estimate was published in 2020. It showed that only 22% of the evidence was reliable. 10% of medical treatmentsThese estimates were based upon high-quality evidence. This estimate was based on only 151 studies.

Others insist that they will continue to be able to do so. most treatments must work. How else can we explain why we live for ten years? longer than our great-grandparents? Nevertheless, the increase in life expectancy can be explained at least partially by public health measuresClean water, better nutrition, and restrictions on smoking.

A better picture

An international team of researchers from the U.K., U.S., Switzerland, Greece, and Switzerland conducted a large study of 1,567 different health care treatments to settle the debate about how many treatments are based on solid evidence. The sample included all Cochrane Reviews treatments between 2008 and 2021. Cochrane Reviews are rigorous studiesThese combine all available evidence on treatments. They are frequently cited in national and international publications. health care guidelines.

Cochrane Reviews introduced a system called “Cochrane Reviews 2008” in 2008. This year was the cut-off. grading quality of evidence and strength of recommendations (Grade)To rate the credibility of the evidence. Grade is more accepted than the earlier estimates which relied on opinions. more than 100 organizations around the world. Grade can be used to indicate a quality rating of very low, medium, low, or high.

The study revealed that 95% do not have sufficient evidence to support their benefits. Worse, only 33% of Cochrane Reviews report harms.

It is especially alarming that the health effects of health care interventions are rarely quantified. To a doctor or patient, decide whether to use a treatmentThey must determine if the benefits outweigh any potential harms. If the harms are not properly measured, an “informed choice” is not possible.

Grade may be too strict. This could be a limitation of the study. Patients and doctors may be open to using treatments that aren’t supported by high-quality evidence. However, they should be supported by moderate-quality evidence. Even if this is true the study found that less then half of treatments are supported with high- or medium-quality evidence.

Patients suffering from conditions that do not have any effective treatments may be open to trying treatments that aren’t supported by high-quality evidence. These patients should not be restricted by the results of the study.

The sample may not have been representative. The theory is that treatments in recent Cochrane Reviews may not be as effective or have lower-quality evidence than those tested in older treatments. This seems unlikely, however, considering the rigorous nature of Cochrane Reviews.

Doctors can use this technique in practice. “off-label” treatmentsThese are less likely to have been analyzed in Cochrane Reviews, and generally have not lower-quality evidence to support them. Despite these limitations, the study showed that most treatments were not supported by high quality evidence.

Patients, doctors, and those who pay for them might want to concentrate on treatments that have high-quality evidence. Research funding should be used to generate high-quality evidence for treatments that have been widely used, but are not supported by high quality evidence about their benefits or harms.

Potential harms must be weighed with the same precision as potential benefits. The evidence-based medicine community has been correct to continue calling for higher-quality researchThey are also justified in their skepticism about the quality of evidence for medical treatments. common or even improving.


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