Critical 评价人数不足
读书笔记 The Lungs
lowai

This trial design (randomized controlled trials) is considered the most robust and reliable. However, when I step onto my ICU tomorrow, 90 per cent of what I do will not be based upon this level of evidence. … Tomorrow I may examine all of my patients with my hands and my stethoscope but, surprisingly, there are few studies to support these as useful practices. If the stethoscope were to be invented today, it would most likely not meet the current standards needed for approval of a medical device. Yet they continue to be used due to tradition, culture and a feeling that research studies are not the only arbitrator of what it best.
引自第125页

下面就开始讲medical research的重要性. 说有些病人会觉得为什么医生不看病要做research呢? 不应该要先看好病再做research吗? 然而research对病人, 医院工作人员和医疗系统都好.

对病人而言,

If you take part in a clinical trial, you are more likely to survive even if you only receive the placebo. If you are treated in a hospital that does research, you too are more likely to live than to die. The environments that nurture good research are also more likely to have good communication between staff, fewer vacancies and higher job satisfaction.
引自第129页

然后说医学界发文章的问题. 实验就很难做, 而且ICU trials要在救人的环境下做, 还有病人/病人家属的同意问题. 此外, 杂志存在更喜欢positive results之类的bias.

This selective publishing should not be acceptable in medicine. The former editor of the British Medical Journal has argued that the entire medical journal industry should be disbanded. The powerful ‘all trials’ movement led by Dr Ben Goldacre aims to publicise these issues surrounding clinical-trial data loss, manipulation and concealment.
引自第131页

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