penguins

Cambridge FCE certificates

I have just received a thick brown envelope from Mrs De Voghel who organises the Cambridge exams in Louvain. In it were the official certificates. I will leave them in le bureau 5/6 next week Tuesday, and you'll be able to retrieve your official certificate, to be framed and proudly displayed on the living-room wall :-) . If someone could tell Soumia, it would be very kind.

Evidence-based medicine

You can find here the rest of the synthesis on evidence-based medicine (6ce).>

Dangers for doctors trained in Evidence Based Medicine

Example:

Dr Daniel Merenstein has a male patient, 53, no sign of prostate cancer
the doctor explains the possibilities
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A bood test is available to detect Prostate Specific Antigens
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early detection of prostate cancer

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tests, biopsies

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treatment

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side effects: incontinence : impotence
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First possibility: the cancer develops slowly |	Second possibility: the cancer spreads fast |
With or without treatment, the patient would have lived vecause the cancer develops so slowly anyway	early detection would not have made a difference anyway

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the patient decides not to take the PSA test
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years later, he develops a very aggressive form of prostate cancer
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he sues dr Merenstein
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he wins $1 million in damages
though treatment would not have made any difference

conclusion: practising EBM can be dangerous, even if the doctor is right in his analysis

EBM limits

sometimes random tests are not necessary or not possible
examples: - electric shock therapy for patients with heart failure (it's so obvious it works no tests are necessary)
- antibiotics in case of pneumonia (idem)

EBM is a moving target

In the case of hormone replacement therapy and whether it protects the heart of menopausal women, one could say that the principles of evidence ased medicine were respected:

1. it's true (based on the data available at the time, with a sample that was later revealed to be unacceptable)

2. it's false (based on the data we now have)

3. it might be true ... in some cases, if it is given immediately after menopause starts, and for a limited time

EBM = being governed by data

The principle is spreading to other fields:

1. nursing

2. education

3. philanthropy (cf the Bill Gates Foundation, based on results)

4. politics (cf the Global Warming debate)

But medecine is the best field of application.
Ideal: EBM + history of the patient + examination + looking at what the patient prefers

Medicine's secret statistic

the effectiveness of a drug is also measured by its NNT (Numbers Needed to Treat)

Example: testing statin, an anti-cholesterol drug

normal testing prcedure: two groups

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with statins |	without statins |
30% fewer heart attacks

But you should only consider the number of people

who will have a heart problem in earch group

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so the statin group becomes

So maybe the difference made by statins is one heart attack fewer in a group of 1000 people

NNT = minimal number of people taking the drug to avoid one death.

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NNT for statins = 50

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So 50 people have to take the drug for 1 heart problem not to occur,

and it might have been a minor problem

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so it is less obvious that taking statins preventively is a good idea

if you are healthy becaues there are problems:

1. they are exensive

2. they could damage the liver and muscles of the patients

3. you have to take a blood test twice a year

Public health ooficials avoid NNT (they want to save as many people as possible)

Pharmaceutical companies avoid NNT (they want to sell as much as possible)

English exams

Congratulations,
you've obviously come
to the right pace.
As you can see
marking is still in progress.