The Antidote

Counterspin for Health Care and Health News

Monday, July 28, 2008

Straight shooting on evidence from the NYTimes

Just noticed a new series exposing health care interventions that don't work, in the NYtimes... not in the health section, but in the business section. The first article is on an apparently dangerous prosthetic hip socket, and highlights the US' failure to implement device registries that could allow the identification of faulty implants of various kinds.

Here's the blurb:
The Evidence Gap: An Imperfect Picture

Articles in this series will explore medical treatments used despite scant proof they work and will consider steps toward medicine based on evidence.
I don't know how many of these are planned, but I imagine they could fill a couple years' worth of weekly columns.

Regarding this article, I'd quibble with the idea that registry data are evidence, per se; the problem with interpreting the data is that there are no controls. One application for registry data stems from the fact that pre-market randomized trial data that provide actual evidence for devices (and drugs for that matter) are inadequate. In this case, the faulty devices in question were found to be contaminated with oil, more of a manufacturing quality-control issue than a general validity issue. The former point still holds, but registries can still provide a useful function in pointing to problems.

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