COMMENTARY

Is the Current Standard of Medical Practice for Treating Venous Thromboembolism Simply Wrong?

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September 09, 2004

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A patient has a disease. A physician invents a treatment that seems to make sense and tries it. If the patient improves, both the physician and the patient may credit the treatment. This is an anecdote and proves nothing. But, the treatment is tried again and the next patient improves. Soon, the physician believes in the treatment and tells colleagues about it. They try it and more patients recover. So the doctors write an article about their observations. What now should happen is called the controlled clinical trial with randomization, blinding, and statistical power, the gold standard for evaluating interventions. Unfortunately, what often does happen is simply a proliferation of use of the treatment before it has been adequately tested. When enough physicians in a given region use the treatment, it becomes labeled as the standard of practice. It may even become required of other physicians to use even though it has never been proven. Elsewhere in today's MedGenMed, author David Cundiff argues from a lengthy literature that such a conundrum obtains for one of the most commonly practiced medical interventions, anticoagulation therapy for venous thromboembolism.[1] Many physicians will disagree with Cundiff's conclusions, some strenuously. But I believe that the data, as he presents them, are pretty impressive. I recommend you pay attention to this challenge of a medical sacred cow. That's my opinion. I'm Dr George Lundberg, Editor of MedGenMed.

Readers are encouraged to respond for the editor's eye only or for consideration for publication via email: glundberg@webmd.net.

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