Grand Rounds: scientific evidence in health

Grand Rounds are up at Signout, a blog by a first-year resident. This issue’s theme is the interface of scientific evidence with health and healthcare. The issue is set up as a scientific paper.

As the host noted, there certainly is a range in critical thinking found among medical professionals.

Among the best reading:

· An in-depth examination of why alternative medicine should be subject to the same rigorous validation methods expected of allopathic medicine, at Respectful Insolence.

· An expose showing how one critic of vaccination spins statistics in favor of her argument by leaving out an important number: relative risk, by Dr. Flea.

· A thoughtful piece on whether what we know about health changes our perception of health risks, by Shinga.

· And kindly selected for inclusion was my post showing how data on pediatric overweight were manipulated to create a message about obesity that was never really there.

But if you read nothing else, read the post by The Blog that Ate Manhattan who takes on the persona of Carnac the Magnificent and wittily forecasts the future — a world where evidence is completely irrelevant, as long as the marketing is good. It’s brilliant.

First there is slick direct-to-consumer advertising campaign, in this illustration, it’s for an implantable cardiac defibrillator... Then Carnac predicts that in the upcoming years:

Patients will start calling and coming in to their cardiologists asking if an ICD is right for them....[The manufacturer] will partner with patient arrythmia advocacy groups (or create them if they don't already exist). These groups will need a catchy name like "The Campaign the End SCA -Sudden Cardiac Arrest", a celebrity or survivor spokesperson and a mission. Soon... Legislation will need to be passed mandating coverage of ICD's and T-wave Alternans on demand, regardless of indication. No problem. [The company] will "partner" with some government lobbying group with a benign sounding name like "Women in Government" and get that legislation passed asap.... A few business-saavy cardiologists will make a fortune running a chain of drive-through ICD Centers implanting on demand. Most cardiologists, however, will continue practicing evidence-based cardiology, and will offer ICD's to patients based on real indications, and not just peace of mind....The first doctor will get sued for declining to refer for an ICD. The story will run on 20/20, be picked up by Reuters and hit all the papers. The use of ICD will increase exponentially as cardiologists everywhere try to avoid a lawsuit.... Cardiologists everywhere will get sued for complications related to implanting the device or misfiring of the device. These stories will not get much newsplay....

Great stuff and a lot more fun than Grand Rounds at the hospital.