The inprecision of evidence based medicine

See on Scoop.ithealthcare technology

We have a rarified opportunity because what we’ve had in medicine is all population based everything we do in medicine is based on the population all the evidence that we have so when we do a clinical trial that shows that Lipitor, the number 1 prescription drug in history in terms of sales, has a heart attack incidence in the treatment group of only 2% whereas the placebo group was 3%.


That is a 33% reduction of heart attacks and it becomes the number 1 prescription drug in the world until it became generic, that’s the best evidence there is in these tens of thousands of patients in trials we’re talking about one in one hundred patients deriving benefit, not about their LDL cholesterol/bad cholesterol going down in the laboratory but rather are they getting protected from heart attacks. Let’s say it’s 2 or 3 per hundred even 4, what about the other 96 that are taking a drug for the rest of their lives without any real evidence that is based on an individual not on a population.


That same principle in medicine today which is the best we have “evidence based” often times it’s “emanence based” these guidelines that draw on no evidence but a bunch of people sit around a room and come up with the guidelines but the problem is it’s so imprecise we have mass screening all women should have a mammogram every year after age 40 when most women have zero risk of developing breast cancer for the rest of their lives and that’s the same for all these procedures we’re doing and in many ways this fosters the waste we have in healthcare and when you think about $300 billion in prescription drugs and we know that at least $100 billion are unnecessary and unmatched for the patient and not having the effect we would like now we can switch that population based medicine for personalised medicine because we have new tools that we didn’t have before

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