Christine Stirling: Move over RCT—time for a revised approach to evidence based medicine – The BMJ – Christine Stirling – Oct 2017
We are stifling our capacity to use research evidence for patient centred outcomes by privileging RCTs
In the two decades since Sackett et al outlined their definitive account of evidence based medicine (EBM) and evidence hierarchies in The BMJ, randomised controlled trials (RCTs) have gained a position of overwhelming dominance that appears to surpass the original intent of EBM.
From the first publication of an RCT in 1948 to today, RCTs have come to dominate the evidence landscape, gaining both research prestige (which translates to funding and publications) and medical authority. Continue reading
Reporting of Positive Results in Randomized Controlled Trials of Mindfulness-Based Mental Health Interventions – PlosOne – April 8, 2016 – Free full-text study
A large proportion of mindfulness-based therapy trials report statistically significant results, even in the context of very low statistical power.
We have the same problem with the studies used to support the CDC guidelines.
The objective of the present study was to characterize the reporting of “positive” results in randomized controlled trials of mindfulness-based therapy. Continue reading
Increased use of heroin as an initiating opioid of abuse. – PubMed – NCBI – Addict Behav. 2017 Nov;
Note to CDC: data now clearly show that prescribed opioids are *not* the initiating drugs for addiction and fatal overdoses, so stop harassing pain patients!
Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics.
Spoiler alert: their hypothesis was proven true. Continue reading
CDC Removes Reference to Disputed Chronic Fatigue Therapies From Website – 07.26.2017 / By David Tuller
This is another case of the CDC promoting faulty therapies for chronic illness.
I used to think that the CDC, with its access to all global research, was the final authority on general health care. But now I’m disillusioned about this powerful government agency after finding nonsense therapies being promoted for other problems, like chronic fatigue, not just chronic pain.
For years, the U.S. Centers for Disease Control and Prevention recommended two controversial treatments for ME/CFS, the illness often known as chronic fatigue syndrome:
- a program of steadily increasing activity, and
- a specific form of cognitive behavior therapy. Continue reading
Major Stanford Study Indicates Chronic Fatigue Syndrome (ME/CFS) is Inflammatory Disorder – Simmaron Research By Cort Johnson – August 11, 2017
The study examined the levels of a very large number of cytokines (n=51) in the blood of a very large number of patients and healthy controls (ME/CFS=186; healthy controls= 388). Age, sex, race and something called “nonspecific binding” were accounted for.
One of the biggest ME/CFS immune studies ever undertaken, done at a top University, this was a study that we dearly didn’t want to fail.
This is the kind of study likely to be labeled “definitive”. Continue reading
This is an essay I wrote out of sheer frustration
I’ve noticed a consistent error in the latest research on opioid therapy: All negative outcomes of opioid/pain research are attributed to the opioid medications instead of the underlying pain.
Researchers willfully ignore that opioids were originally prescribed for unbearable pain and proceeded as though the motivation for these medications were insignificant or irrelevant to their studies.
The many detrimental outcomes these studies find are exactly what you’d expect from a person suffering long-term chronic pain. But researchers place the blame for any negative outcomes on the opioid medications taken to relieve pain, not on the pre-existing pain itself. Continue reading
This PubMed article piqued my interest because of the following paragraphs which seem an uncanny description of the hyper-sensitivity that so many of us suffer from.
It may be that people with ADHD are afflicted with a defective filtering system such that their brainstem reticular formation does not block out irrelevant stimuli. These people appear to be aware of every sound, every object, every touch, and they all merge in disorganized behaviors that are difficult to tolerate
At a deeper level, ADHD is a problem of communication among brain cells, or neurons, possibly involving the neurotransmitters that carry inter-neural messages. If the messengers that inhibit incoming stimuli are deficient, too many signals get through and create confusion.
Attention-deficit-hyperactivity disorder and reward deficiency syndrome – free full-text PMC2626918 – 2008 Oct; Continue reading
C-reactive protein and cold-pressor tolerance in the general population : PAIN – July 2017
Pain and inflammation are related: systemic inflammation may lead to a variety of pain states, and, in turn, persistent pain causes an upward adjustment of proinflammatory mediators that sometimes elicit a prolonged low-grade immune response, leading to long-lasting, subclinical inflammation.
The cytokines that are produced during inflammatory responses are the main stimulators of the production of acute-phase proteins, specifically C-reactive protein (CRP).
C-reactive protein is a nonspecific systemic marker of infection, inflammation, tissue damage, malignancy, and autoimmune disease.
Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects – 2006 May – free full-text PMC1459894
This meta-analysis was carried out with these objectives:
- to compare the efficacy of opioids for CNCP with other drugs and placebo;
- to identify types of CNCP that respond better to opioids; and
- to determine the most common side effects of opioids. Continue reading
Statistics and the Rise of Medical Fortunetellers – Michel Accad, MD – Tex Heart Inst J. 2009; free full-text PMC2801944
This article makes the increasingly forgotten, yet increasingly important, point that population statistics do NOT apply to individuals.
There was a time when the foretelling of future events was an undertaking of prophets, palm-readers, and weathermen. In recent years, however, the medical profession seems to have embraced this activity with a great deal of enthusiasm.
But hyperbole is also what comes to mind when one examines the claims that authors of such reports make. Continue reading