Sometimes a cartoon says it all. This one does it for me.
It's funny, but it's also sad. So many small discoveries are magnified by PR departments and then news media that the public has become cynical about every new discovery.
Some day we'll find cures for cancer, AIDS, and diabetes, and people will read the stories in the newspaper or see them on TV and think, "Yeah, right. Next week they'll announce that the cure causes something even worse."
Sadly, this sort of thing has been going on for a long time, and I doubt that it will change in the near future.
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You will find this interesting:
ReplyDeletehttp://junkfoodscience.blogspot.com/2009/05/seeing-evidence-tighter-control-of.html
Anonymous, I'm not sure what that blogpost has to do with the point made in the cartoon, but it's one of many analyses of these statistical studies.
ReplyDeleteI used to subscribe to that blog but unsubscribed because I sometimes found factual errors but there was no way to communicate with the author to alert her.
I don't put a lot of weight on any of these large trials, because there are simply too many variables involved: different patient groups, different end points, different time periods, different methods of statistical analysis. There are so many papers out there, you can find a paper to support almost anything you want to believe in.
And you can say that Drug A has no effect on mortality, and it might be true. But if one person dies intact and the other one dies at the same age blind, with no legs, on dialysis, then perhaps mortality isn't the most important factor.
What is important is how any particular therapy affects an individual patient. If you require 25 different strong drugs plus giving up all the foods you enjoy and spending all day on a boring exercise bicycle to maintain an A1c of 6.5 or less, so you're miserable, then it's probably not worth it.
If you can lower your A1c with a few well-studied drugs and don't mind your new way of eating, then it is.
Looks like she's pushing the ACCORD effect - give diabetics a high carb diet and chase it with heroic quantities of meds - TZDs have been particularly implicated - and the patients do worse. So let's save money and not treat them.
ReplyDelete(AFAICR the UKPDS and other studies which found complications increasing with A1c used metformin and sulphs predominantly, and insulin.)
IF ONLY someone would put up the money to study well controlled diabetics who rely on a rational diet. I can think of a couple of charities who could finance this but haven't and won't. In fact I've met several diabetics who've been turned down for several studies because they were "too well controlled"
(sigh)
Absence of evidence is not the same as evidence of absence. Just because they choose not to study it doesn't mean it doesn't happen, it just means that the evidence remains anecdotal
Many of those big trials are sponsored by drug companies. They want their drug to show an effect. People who have an A1c of 5.5 aren't likely to want to try an experimental drug.
ReplyDeleteIf you start with someone with an A1c of 8, then they could in theory go down 2 points to 6. If you start with someone who has an A1c of 5.5, they'd be at 3.5 if they went down 2 points, and that's too low, so the potential is lower and the drug companies don't want that.
I was turned down for a drug trial at Joslin because my A1c was too low. I didn't particularly want to be in it anyway, so I wasn't very disappointed.