Wednesday, April 3, 2013

I Guess "Case Studies" and Anecdotes *CAN* Be Usefull Afterall

1 Boring Old Man:
The scheme boxed above [about RCTs, randomized controlled trials], while initiated as a protective maneuver, is actually designed to detect smaller differences – differences that might not even be apparent without the statistical rigor described. One would hardly need more than my one case of terminal congestive heart failure treated with Ethacrinic Acid to know that drug was a powerhouse diuretic – dangerously powerful. The same is true of Digitalis, Insulin, and Prednisone. They don’t work statistically. They just work. The same would be true of Thorazine which is closer to a sledge-hammer than something subtle requiring statistical proof. The issue with all of these drugs is about their safety, not their efficacy. So the coming of the clinical trial technology greatly expanded the ability to detect much more subtle levels of efficacy.
What frustrates me is that medical science (in the form of pharma-trials) is chasing ever smaller effect sizes (Statins, anyone?) while at the same time ignoring what could be gained be removing evolutionary novel foods from nutrition – something like the Paleo Diet, that "just worked" for me. It did not work "statistically", but it "just worked", just like flipping a switch.

Why can't they take MS patients (for example) and put them on elimination diets, where you remove one component from the diet and see what it does? Have one arm of the study where you remove dairy, one arm where you remove grains, one arm where you remove dairy and grains, and so on – there are other possibilities. Or do this with Behçet's and dairy?

I feel like medical science is stuck, unable to ask the right questions anymore, unable to question what is right and what is wrong with all that knowledge they have gathered. The only way to get themselves "unstuck" would to question everything. Are (whole) grains actually healthy? Is dairy actually healthy? Is an increased consumption of PUFAs actually healthy? If not, for which groups of patients with what diseases? Or are there even problems with these foods that affect everybody negatively?

Until the medical science starts questioning whether the foundation of nutrition is really what the medical mainstream thinks it is, until then medical science will remain stuck.

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