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A bit of perspective

More evidence-based surgery

" are generally ready to believe what they want to believe " is a quote direct from Julius Caesar in his Gallic War. Most of us have our personal biases, honed by experiences bad and good. The trouble with biases is that they can obscure the truth, and we occasionally need to take a bit of a step back and question them.

Bandolier's first step back this month involved low dose aspirin. Prophylactic use of aspirin to prevent vascular events has been visited before, notably in Bandolier 86 and 108. This Bandolier Internet site has even given aspirin its own special place, where all the evidence we have found to date has been gathered together. Our view was that it was a good idea in many people, but that we had to beware of the harm that it also caused, especially in population terms. A new study from Scotland reinforces that bias.

When it comes to complementary therapies, Bandolier is sceptical. The perspective has often been one of promise, but the better the study, the more negative the result. The exception is with chemicals, like herbal remedies or glucosamine, where evidence is better. Avocado/soybean unsaponifiables (don't ask) seems to have some weight behind it, but noni juice is a no-no.

Bandolier also looks at perspectives relating to the loss of quality of life with osteoarthritis, and regaining quality back to the population norm on having a joint replacement. Lots of QALYs for our health economists to play with, and perspective. We could do with some clever folk to pull all the evidence on arthritis together to give even more perspective about what to do, when, and with whom.

More evidence-based surgery

Not a request, but a rather a celebration. Bandolier often hears it said that surgery should be more evidence-based. Those who ask should stick their heads into a computer and do some searching. There is masses of good evidence on surgery out there - literally hundreds of good systematic reviews and lots of other good stuff.

A simple example of different methods of harvesting veins for use in coronary artery bypass surgery makes the point. There were lots of randomised trials, lots of patients, and consistent results. Super sensitivity analysis as well. Someone should be pulling this evidence together for professionals and public.

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