COMMENTARY

Clinicians 'Want to Do the Right Thing'

Lack of Evidence Should Be Shared With Patients

Gerald Chodak, MD

Disclosures

September 27, 2013

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Hi. I'm Dr. Gerald Chodak for Medscape. During the past 3 years of doing this video blog, it has been my intention to try to identify a current state of practice that is good for patients and to challenge studies that don't support or prove the right thing to do.

I came across a paper by Prasad and colleagues[1] in Mayo Clinic Proceedings that provides some additional support for the way we practice medicine and the problems that we have in counseling patients. The authors reviewed studies that were published in the New England Journal of Medicine over a 10-year period, including papers that challenged current therapies or investigated new therapies. They looked at studies that were testing whether the standard of care that was in practice was good, bad, or supported. Unfortunately, nearly 40% of the studies that were testing the existing standard of care were found to be negative studies, meaning that the randomized study did not support the standard of care being used at that time. As it relates to the field of urology, there are several studies worth mentioning.

There was a study of vitamin D and calcium for osteoporosis or preventing fractures that did not have support. The use of saw palmetto, which is thought to help men with urinary symptoms, did not have support. Also, the use of DHEA and testosterone as a way of strengthening patients' body functions did not have good support.

Where does this leave us going forward? Too often, medical bodies make recommendations on a consensus of what is thought to be the standard of care rather than on the basis of randomized studies that we can trust. If that is the case, doesn't it follow that we should be telling patients that this is an opinion, that it's the best that we can come up with, but we cannot say for sure that it is the right thing to do? After all, the public is trusting us to give them good information, but about 40% of the time that information may be incorrect.

In the area of prostate cancer, how many forms of therapy are being recommended for patients in the absence of data that prove it's the right thing to do? I think this is a serious shortcoming. Unless we have an intention to do more randomized trials to figure out the right thing to do, we are likely to spend a lot of time and money -- and maybe cause a lot of harm to our patients -- because we are telling them to do things that are not supported by good scientific data.

At the end of the day, we all want to do the right thing for our patients. But if we don't do the right studies, we may be unable to accomplish that goal. I look forward to your comments.

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