|Blog de Luis Mochán||
Sun, 17 Jan 2010
Reading about kyphoplasty and the evidence in favor or against it, I read the terms evidence based medicine. Its existence implies that most of the medical treatments in use are not evidence based, i.e., based on statistical analysis of many cases with appropriate controls, double blind tests, etc. In the case of kyphoplasty and vertebroplasty, after 25 years of use, there are only two double blind studies with about 130 patients with negative results. The results have been contested but the criticisms, although reasonable (there was a pre-selection of cases, all interventions were performed by the same surgeon, the amount of cement was inadequate) have not reached yet refereed medical journals. (My mother is having kyphoplasty next week).
Most medical doctors draw upon their (limited) personal experience and reported clinical cases, they are not trained statisticians and, in any case, they don't have access to massive data banks to perform data analysis. Thus, I suggest that, if it doesn't exist yet, a single database should be set up to attempt to collect information from all cases attended by all physicians world-wide, so that a data mining program might find enough evidence about a given treatment in given circumstances that conclusions can be drawn with some certainty. It should be simple to use, so that physicians are encouraged to use it. Maybe it can offer to be a substitute to paper files, so that information about given individuals may be obtained using the appropriate passwords, replacing in-office files and motivating physicians to use it. Maybe it should also allow patients to fill their own cases and to retrieve them when required, making their clinical history available to the doctor of their choice. Anybody else should then be able to obtain and analyze information that doesn't compromises the anonymity of doctors and patients.
Sat, 02 Jan 2010
I spent all morning today in the hospital, as a very close person required a series of studies: a choice between nuclear magnetic resonance 3D image of the brain and computerized axial tomography (CAT) angiography and doppler angiography. Nearby there was a positron-electron tomography (PET) unit. These techniques haver revolutionized medicine, but many people ignore that they exploit a lot of sophisticated modern physics. I have a MD friend who, even though he analyzes PET scans routinely, he was unaware that the PET unit works with antimatter; of course, he didn't know anything about integral transforms and their use for 3D imaging in all kinds of equipment. It would be nice if a series of papers were written relating advances in basic physics and mathematics to advances in medicine. It would be useful to show that physics research is important not only for yielding more efficient industrial processes, but also for helping to alleviate human suffering.
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