
One in ten medical treatments are supported by high-quality evidence – study - elorant
https://www.sciencealert.com/around-90-percent-of-your-medical-treatments-isn-t-backed-by-high-quality-evidence
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csr86
I have had failed ankle surgery and have read some research papers on the
procedure that was done to me.

Often, the method was asessed by asking patients to score their situation
before and after the surgery (e.g one year later).

For sure, many people try to be positive and give too optimistic scores. At
least I felt it hard to admit that the costly procedure had failed and saying
it to my surgeon didn't feel easy.

What I fear is, there are many research papers done using patient questionaire
and giving us biased results

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neolog
What would be better than patient questionnaire?

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Scoundreller
Functional assessment? Range of motion, strength, etc.

~~~
Brakenshire
You need devices which can objectively measure the strength of something like
an ankle in multiple vectors of motion. And then algorithms which can combine
the data into a meaningful index.

~~~
viraptor
I'm not sure if that was sarcastic or not, but you mean devices like hanging
scales and string, and a protractor?

~~~
liability
Ah, but it's a _medically certified_ protractor! Disposable (for safety of
course) and $500 a pop.

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MiroF
One in ten medical treatments that have _had updated reviews recently_ are
_currently_ lacking high-quality evidence.

I think it would be worrying if every medical review had high-quality
evidence. Just because it's in the Cochrane database doesn't (to my
understanding) mean that it is a frequently used treatment.

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jjcon
Bingo - this is not one in ten medical treatments administered, it is one in
ten possible medical treatments.

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spzb
Spam blog republishing this article : [https://theconversation.com/only-one-
in-ten-medical-treatmen...](https://theconversation.com/only-one-in-ten-
medical-treatments-are-backed-by-high-quality-evidence-145224)

~~~
evolve2k
> Please submit the original source. If a post reports on something found on
> another site, submit the latter.

Yes please change the link to the original source as per the HN Guidelines.

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ncmncm
If this list includes depression treatments, they are examples of treatments
for which "high-quality evidence" of the sort that is demanded is impossible.

The only way to know whether a person has the version of the disorder that
responds to a particular drug is to administer that drug and see.
Psychiatrists try prescribing different drugs until they hit one that works,
or give up. Imagine designing a randomized-controlled-trial for that.

If you need help: first, select a group already using the drug. Split them up
and give half a placebo. See which get worse. But first, find someone
unethical enough to run it, and admits it.

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doesnotexist
The article is based off someone scraping all the Cochrane reviews and doing
ctrl-f for the phrase "high quality evidence"... unfortunately the headline
makes great click bait but I think it's misleading as most people are not
versed enough in medical evidence and come away with an incorrect impression
as to the evidence supporting medical interventions today. Even an
intervention with "moderate" level of evidence supporting it has already
passed a bar far beyond what most people would imagine.

As to your claim about antidepressants, psychiatry and psychopharmacology is
abound in RCTs, many on treating depression with antidepressants. You are
perhaps mistaking a common clinical approach (outside of clinical studies) for
finding the best medical management for _single_ patient with how clinical
evidence is procured in the first place. There are more Cochrane reviews under
"mental health" at 679 than there are under "orthopedics" at 478.

Also, when RCTs are proposed, no matter if they placebo controlled or not,
they are reviewed by IRBs and ethics committees.

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ncmncm
Yet, we very frequently read about RCTs that failed to find any significant
benefit from this or that antidepressant, insisting therefore that
psychiatrist are a bunch of quacks and people with depression are malingerers.

Those RCTs are administered by real people who are each either unaware that
there is no way to get meaningful results from such a trial, or are motivated
to produce meaningless results that can nonetheless be published to mislead.

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strstr
This number is shocking, but it is not weighted by usage. Just because a
medical treatment is a treatment doesn’t mean it’s in common use.

On top of that, I find it 100% believable that doctors use understudied
treatments. The reverse makes a lot more sense. Treatments get studied after
people have tried them, and believe they warrant further study and more
frequent usage.

Consider coronavirus treatments, at first we had very little idea what to do,
beyond inferring based on past virus with a similar symptom profile and
reasoning from first principles. Later on, we slowly but surely identified
effective treatments (corticosteroids/prone position/...) after people tried
them. Even later, we had descriptive studies of past effectiveness. I assume
most treatments go through a similar progression (covid treatments go through
this progression on fast forward).

Medical studies are slow and retrospective. Fundamentally that gets you this
1/10 figure.

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TheRealPomax
Cool, what was that number 5 years ago? 10? 20? 50? Are we making progress or
have we only just now established a baseline and the fact that we now know
it's "1 in 10" is a number that lets us draw exactly zero conclusions with
respect to whether that's good or bad, and more importantly, better or worse
than before?

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ashton314
Neil Postman has a chapter about how medical technology ha changed what people
expect from medical treatment in his book _Technopoly_. The short of it is
that we’ve become reliant on technological solutions that we _demand_ the
maximum treatment available land we litigate when the doctor doesn’t order the
maximum number of tests or prescribe the maximum treatment, rather than rely
on the doctor carefully listening to the patient and meting out more
protracted treatments. I think that it’s good that researchers try every
possible avenue for _research_ , but I think our obsession with increasingly
technological “solutions” is driving an unhealthy environment of mistakes in
treatments in the interest of delivering the maximum possible.

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phkahler
They talk about blind trials being better, but then:

>> An exercise trial cannot be "blinded": anyone doing exercise will know they
are in the exercise group...

How exactly can knowing which group you're in cause a placebo effect or any
other relevant effect in that case?

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jdmcnugent
Blinding is a way to actually reveal placebo effects, and double blinding
(blinding the examiner to which group the subject is in) helps negate observer
bias.

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jvanderbot
Medicine is old. Many uses of penicillin are not well studied, because it was
the first real antibiotic and we just _know_ it works for what it does. Nobody
can get funding to study penicillin uses unless it somehow magically can cure
something new.

~~~
dehrmann
There was article in The Atlantic a few months ago about fluoride in water not
probably works, but isn't particularly well-studied, and long-term side
effects aren't really understood. At least with fluoride, it's so widespread
that you'd expect any serious issues to have surfaced by now.

[https://www.theatlantic.com/magazine/archive/2020/04/why-
flu...](https://www.theatlantic.com/magazine/archive/2020/04/why-fluoride-
water/606784/)

~~~
akimball
You mean like increase in autism, depression, and decrease in population mean
testosterone?

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askvictor
This is a bit like the dental floss thing of a few years ago - someone
suddenly realised there was no evidence backing the use of dental floss; cue
media frenzy that dental floss is useless. No it isn't; just no-one bothered
to study it. I'm sure that there isn't any high-quality evidence that
'removing your hand from a hot stove decreases burn injuries.' More evidence
is a good thing, and is needed in many cases, but and there is also a heap of
questionable medical treatment out there, perpetuated by the status quo.

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Obi_Juan_Kenobi
That is not an accurate summation of the evidence. 11 publications were used
to analyze the efficacy of dental floss, a some dozens more for other inter-
dental cleaning methods.

[https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12363](https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12363)

Characterizing this as 'absence of evidence' is incorrect; the specific issue
has been investigated by several independent investigators and consistently
fails to find evidence of efficacy. Even with much higher sampling and
statistical power, if any effect was observed, it would likely be well below
anything that could justify flossing as a health recommendation, especially
over IDBs.

~~~
askvictor
I stand corrected.

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akimball
Very few of them are, because each case is different.

Another way to put this: EBM is only good for about 1 in 10 treatments.

Great for writing papers, though.

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newsbinator
> 22 percent had very low-quality evidence.

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otabdeveloper4
Well, yes.

Experimenting on humans is unethical and (mostly) illegal.

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pessimizer
Treatments with bad evidence are no better than experiments. Treatments also
only become acceptable over time, after we observe that we're probably not
killing or seriously hurting people. Of course, sometimes we just rationalize
it when the treatments actually are killing people, if the people profiting
from them aren't actually engaging in outright concealment and fraud.

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AshamedCaptain
But, whenever there is a single study claiming something new, it quickly goes
into mass media (including HN), and calls for "skepticism until this is
reproduced a couple more times and the positive results significantly
outnumber the negative ones" are quickly downvoted.

