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When the Risk of Treatment Outweighs the Benefits…

New studies indicate that a drug designed to reduce the risk of one kind of stroke may provoke another.

Theodore Dalrymple


July 1, 2014 - 2:00 pm
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In principle medical research is supposed to result in unequivocal guidance to doctors as to how to treat their patients. As often as not, however, the waters are muddied as much as cleared. Two papers in a recent edition of the New England Journal of Medicine about atrial fibrillation and the cause of stroke illustrate this. It has long been known that people with a clinically-detected chaotic heart rhythm called atrial fibrillation (AF) have an increased incidence of stroke by embolism; and likewise that no cause of such stroke can be found in up to 40 percent of patients who suffer from one. Their strokes are called cryptogenic. The two papers addressed the question whether, if you monitor patients with cryptogenic stroke for long enough, some or many of them will turn out to suffer from AF. This is important, because it is generally agreed that, in patients with clinically detected and symptomatic AF, anti-coagulation reduces the subsequent risk of stroke. AF, however, is not an all or none phenomenon. Some people suffer it continuously, but others only occasionally and for only a few seconds at a time. The additional risk of stroke in the latter is unknown, but is an important question because the anticoagulation designed to reduce the risk of stroke is not itself without risk, including that of another kind of stroke, the haemorrhagic kind. In other words, the risk caused by treatment could outweigh its benefits.

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All Comments   (3)
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There is no drug out there that is not also a poison (chemotherapy drugs being the most obvious example).

That said, this article MIGHT be a description of a flawed trial design - in which case, the flaws should certainly be corrected, and added to the body of knowledge about what to avoid in the future.

For those with chronic, severe AT, however - do not throw out the baby with the bathwater. Unless you don't mind killing them.
33 weeks ago
33 weeks ago Link To Comment
Yes, far too much of modern medicine is like that, underdetermined dispositions. Then you hand a doctor a tool that helps in some cases, but we're not sure which cases, or if it is just random cases, and ditto the negative (and even fatal) side effects, and what is a rational doctor to do? You can see many reasons for a modest over-treatment. If the patient dies under-treated, there is a disposition to sue the doctor. If the patient dies over-treated, there is a disposition to blame the treatment! Or to just chalk it up to that old favorite, "Well everybody dies."

We're still decades, if not centuries, away from sufficient science to make more than a dent in this kind of thing. And you know what, even then, I suppose everybody will still die, until we learn to upload a mind into a computer or android or something, but that doesn't seem anywhere close, for better or worse.
33 weeks ago
33 weeks ago Link To Comment
You gotta nail? I gotta hammer...
34 weeks ago
34 weeks ago Link To Comment
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