Some Studies That I like to Quote

Some Studies That I like to Quote - a song designed to get you thinking about the problem with strictly following cardiovascular guidelines/target shooting and NOT using evidence to help you and your patient make decisions. The lab coat logos are from top drug companies, top Rx medications and top guideline producers. Guidelines are useful but make sure you know the evidence or lack thereof.

Yes I know this is the "1,432nd parody" of a song called "Somebody That I Used To Know" by Gotye.

CREDITS

LYRICS AND VIDEO PRODUCTION BY: James McCormack

GREAT VOCALS BY: Shae Scotten and Liam Styles Chang -- 2 guys from a great band called Aivia from Victoria, BC - THANKS GUYS -- check them out at http://www.youtube.com/user/weareaivia

BACKING TRACK: Purchased and downloaded from http://www.karaoke-version.com

LYRICS -- if anybody wants the evidence/studies referred to in this video please email me at james.mccormack@ubc.ca

Guidelines made me feel so happy I could die
I told my patients it was good enough
To lower glucose make them unconscious
I put my 95 year-olds on a statin

I should have known all along that this was wrong
100 over 60 made them fall, they really fall
Stopping salt and fat did not make sense
I really should have looked at evidence
I didn't know that half of guidelines were just opinion

You say I need an RCT
One that actually shows a difference in a real outcome
I'm supposed to know the NNT, and discuss it with my patients
Are you kidding me?

Don't know what a p-value is
You say I need a Cochrane review to help me find some numbers
I hear some surrogates were wrong
And now I need some studies I'm supposed to quote

Now I need some studies I'm supposed to quote
Now I need some studies I'm supposed to quote




Now and then I think of all the things you had me measure
You had me thinking there was always something that was wrong
All that fibre was an adventure
Now I'm passing wicker furniture
Beta-blockers made me feel real slow
And now you telling me about some studies that you need to quote

But now I'm reading RCTs
You get a 1% reduction from a low dose statin




I know now that an A1C of less than 8 is good enough as long as you don't pee
Forget about your CRP
Just don't eat like a great fat pig and go get some activity
I think that I can help you now
I finally have some studies that I like to quote

Some studies
(That I like to quote)
Some studies
(Now I have some studies that I like to quote)

Some studies
(That I like to quote)
Some studies
(Now I have some studies that I like to quote)

(That I like to quote)
(That I like to quote)
(That I like to quote)
(Some studies)

For a spanish translation of the lyrics go to http://rafabravo.wordpress.com/2013/0...
Thanks to Rafael Bravo for doing this.

Overdoing prevention: Beware of regular check-ups, healthism by numbers and genetic profiling

Medicine Drug Pills on Plate (Photo credit: epSos.de)

Overdoing prevention: Beware of regular check-ups, healthism by numbers and genetic profiling

Author : Pierre Biron © 2013

Affiliation : Honorary professor, Faculty of Medicine, Université de Montréal, Montreal, Canada

Full Text

Humane medicine as usually practised by general practitioners is a threatened species. In the old days doctors observed their patients in the circumstances of their lives; at least they watched them walk from the waiting room into the consultation room and they listened more than 123.4 seconds before interrupting them.

Another historical period bore witness to a technological medicine centred on systems, organs and cells, practised by true engineers of the human body, these second- and third-line specialists better paid than a dedicated general practitioner with a good clinical judgment. Medical progress became synonymous with medical specialisations in hospital settings which required expensive machines, expensive drugs and expensive training programmes to learn their use. High-technology fragmented care saves lives but treats Homo Mechanicus.

In the wake of the craze for a healthy lifestyle (mostly associated with our social, economical, educational and environmental status), we’ve entered another period characterized by proactive laboratory-based preventive measures based on schedules to screen for anomalies in plasma molecules, in body images and soon in genetic material, in hot pursuit of markers and risk factors, the significance and utility of which will unquestionably be exaggerated by interested parties.

It is your dossier that is dealt with, and nobody asks you any more how you’re getting on in general; no interest is shown in your social or economic situation, your living environment or habits, whether you live alone; nobody inquires about the stability of your job or your relationship, nobody even touches you any more [1], and nobody wastes any time over non-verbal signals that might differentiate a real depression from a bout of hypochondria.

The ritual stethoscope is applied over the clothes, missing a melanoma brooding on the back; the pulse is felt half-heartedly, a hand is passed over the abdomen without conviction, the blood pressure taken rather too swiftly, the lymph nodes are not systematically palpated, the breasts are examined too coyly. Your life, your body, your worries are less important than your blood assays, your body images, your answers to simplistic questionnaires.

Following the successful dissemination of medicalization (disease mongering), the giving of disease-names to all the natural symptoms that may well be turn up in the course of a life, wealthy societies are now facing prevention zealotry, based on test results and known as health by numbers.

An ideology maintaining that any aberrant value in your specimens is a disease that ought to be treated. If your health check is within standard values, then you are in good health.

If not, you ought to follow official recommendations and make sure your results return to the accepted range. The way is now open for a general intimidation of the population and for considerable wealth for the sponsors of preventive medicines, which a decade ago was already qualified as presumptuous, authoritarian and overbearing by a father of evidence-based medicine.[2]

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Evidencia sobre las actividades comunitarias

European Centre for Disease Prevention and Control (Photo credit: Wikipedia)

Fuente: Medicina Comunitaria


Technical report de los ECDC. Evidence-based methodologies for public health. How to assess the best available evidence when time is limited and there is lack of sound evidence
Texto muy interesante que hemos conocido a través Blanca Botello, compañera preventivista y salubrista  andaluza, con la que tuvimos la suerte de poder desarrollar la herramienta metodológica para iniciar la revisión de las evidencias de las actividades comunitarias de la red “Asturias Actúa”
El esquema básico que utilizamos,siguiendo la bibliografía disponible, es el siguiente:

(Botello B. Cofiño R. Desarrollo de un modelo para la presentación de las evidencias en actuaciones de Salud Comunitaria)

El texto original de la “herramienta” se envió a Gaceta Sanitaria pero debido a que el manuscrito no estaba suficientemente bien desarrollado y estructurado para comprender su pertinencia en nuestro entorno y debido a la gran cantidad de manuscritos remitidos en GS, no fue aceptado para publicación.
De todas formas con las aportaciones realizadas por diferentes compañeros y revisores trataremos de difundirlo lo más pronto posible para que sirva como herramienta para las personas que trabajan en la construcción de evidencias, como bien dice el texto del ECDC, y como nos pasaba en Asturias, en escenarios de tiempos (y recursos limitados.
Bibliografía de referencia:
(1). Proyecto de desarrollo del Observatorio de Salud en Asturias.  Dirección General de Salud Pública y Participación. Consejería de Salud y Servicios Sanitarios. Gobierno de Asturias; 2011.
(2) Population Health Institute. University of Wisconsin. What Works for Health - An Evidence Based Resource. Policies and Programs to Improve Wisconsin´s Health [Internet].  [cited 2010 Jul 20]; Disponible en:  http://whatworksforhealth.wisc.edu/
 (3). Weightman A, NHS Health Development Agency. Grading evidence and recommendations for public health interventions: developing and piloting a framework [Internet].  London: Health Development Agency; 2005. Available from:  http://saludcomunitaria.files.wordpress.com/2007/01/grading_evidence.pdf 
 (4). NICE public health guidance. Community engagement to improve health [Internet]. 2008 Feb [cited 2010 Feb 7];Available from: http://guidance.nice.org.uk/PH9/Guidance/doc/English 
(5) Cofiño Fernández R, Alvarez Muñoz B, Fernández Rodríguez S, Hernández Alba R. Promoción de la salud basada en la evidencia: ¿realmente funcionan los programas de salud comunitarios?. Aten Primaria. 2005 May 31;35(9):478- 483. 
(6) Morales Asencio J. Salud Pública basada en la evidencia. Recursos sobre la efectividad de intervenciones en la comunidad. Rev Esp Salud Pública. 2008;82(1):5-20 
(7) Jenicek M, Stachenko S. Evidence-based public health, community medicine, preventive care. Med. Sci. Monit. 2003 Feb;9(2):SR1-7  
(8) Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Org. 2009 5;87(5):353-361
(9)  Buffett, Ciliska, Thomas. Tool for Assessing Applicability and Transferability of Evidence. [Internet] Hamilton: National Collaborating Centre for Methods and Tools (NCCMT), 2007. Available from: : http://www.nccmt.ca/pubs/A&T_Tool_-
_FINAL_English_Oct_07.pdf.

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