In my last post, I wrote my initial thoughts of an important new study on how the decision to take a medication or have a screening test in the name of prevention is similar to playing the lottery.
I promised to think and write about the study more carefully. My latest thoughts are now published over at theheart.org|Medscape Cardiology.
Here is the intro:
Medicine is easier when people are sick. In treating heart attack or stroke, certainty rules over uncertainty. The best outcome of a heart attack or stroke, however, is not to have had one.
Prevention is where medicine gets hard, very hard. To prevent something that may or may not happen in the future, we operate with probabilities. Preventive medicine also requires us to treat people who are not sick. Given our oath to first, do no harm, that gets tricky.
Current thinking on primary prevention involves applying results from clinical trials to individuals in your exam room. We say taking this drug or having this cancer screening test will reduce your future risk of dying from that disease by x% or y%. But people don’t care about population averages; they want to know their odds of benefit and how much benefit to expect.
A new study, published in Open Heart , provides a novel way to think and discuss these odds. I will try to convince you that this paper may be one of the most important medical studies of recent times.
To read more, click the title of the piece: Primary Prevention: What Medicine Can Learn From Monte Carlo
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