Testing Standard Medical Practices - NYTimes.com

Testing Standard Medical Practices - NYTimes.com

But in 2002, a randomized trial showed that preventive hormone replacement caused more problems (more heart disease and breast cancer) than it solved (fewer hip fractures and colon cancer). Then, in 2009, trials showed that P.S.A. screening led to many unnecessary surgeries and had a dubious effect on prostate cancer deaths.

How would you have felt — after over a decade of following your doctor’s advice — to learn that high-quality randomized trials of these standard practices had only just been completed? And that they showed that both did more harm than good? Justifiably furious, I’d say. Because these practices affected millions of Americans, they are locked in a tight competition for the greatest medical error on record.

Medical markets like this grow through the cracks of trials like Iv-B roots and branches, as the trials become larger and more randomized then the drugs become more V-Bi causing some of these cracks to close up. However these cracks can continue by fiddling trials, holding back negative results, allowing small improvements to be touted as much better than the null hypothesis, as well as miasma like effects. For example a new antidpressants might engender optimism in people which spreads to friends like a miasma, however it might not work better than a sugar pill.

The problem goes far beyond these two. The truth is that for a large part of medical practice, we don’t know what works. But we pay for it anyway. Our annual per capita health care expenditure is now over $8,000. Many countries pay half that — and enjoy similar, often better, outcomes. Isn’t it time to learn which practices, in fact, improve our health, and which ones don’t?

To find out, we need more medical research. But not just any kind of medical research. Medical research is dominated by research on the new: new tests, new treatments, new disorders and new fads. But above all, it’s about new markets.