Thread by @dr_dmorgan

Like @BenMazer, I was bummed to have a op-ed during the riot

In it, I describe the reality that most medical treatments have very marginal effects.

A reality with big implications

d/w @VPrasadMDMPH @lowninstitute @AndrewFoy82 @drjohnm

washingtonpost.com/outlook/2021/0…
1/

2/ If clinicians understood small chance of benefit with most Rx, I feel we would make very different decisions for most patients

Thanks @MikeMadden editor

By taking a medication daily we buy a lottery ticket with a payout often as low as 1% or 2%.

3/ And we can’t know if we won or not…as winning usually means "nothing" happens.

Of course, we assume no bad outcome = benefits,

so 95% or more appear to benefit, not the 1-2% who truly benefit from RCTs

4/ I'm not a medical nihilist like Jacob Stetenga, I believe medicine has good things...

5/ But....
“This phenomenon, in which the perceived benefits of a treatment far outstrip the reality, is surprisingly common. …The benefits are real, but they tend to be very small”

6/ Research often still reports misleading RRR for marginally effective studies— ja.ma/2JpRkUr @jsross119
Drug companies and device manufacturers do the same thing pubmed.ncbi.nlm.nih.gov/10349065/ @DeeMangin

7/ It’s not surprising then that “many clinicians have undue faith in medicines and treatments they prescribe and recommend.”
jamanetwork.com/journals/jamai…

8/ We need to balance harms vs. benefits
lowninstitute.org/wp-content/upl…

9/ “It’s not surprising that many doctors have trouble discussing chance of benefit and harm from treatment. Over their careers, they receive little help in grasping the topic”
There is a better approach jamanetwork.com/journals/jama/…

10/ The task of the doctor is broader than simply making patients physically better, because often enough, we can’t actually do that. We need to realize, or perhaps remember, that our job isn’t only to cure people; it’s also to help them make it through when there is no easy cure