Instead of relying mainly on personal experience with new diagnostic and treatment methods, a wise physician depends on studies reported in the medical literature.
Proof of efficacy of new agents is currently provided by double-blind, randomized, placebo-controlled trials (RCTs), generally involving more than one medical center.
Relative risk values alone give incomplete information. It is necessary to know also the basal risk of the outcome in question and to assess its importance, both medically and personally.
Cost/benefit analyses have become increasingly important in the development of practice guidelines, in the registration of drugs, and in the deployment of screening tests and preventive regimens.
The results of treatment trials of bone active agents must be analyzed in a way that is consistent with the underlying biology.
A physician tries a new bone active agent in his practice. His patients seem to improve and he is enthusiastic. Another physician, trying the same agent, sees little patient improvement but notes serious side effects and becomes convinced that the drug is more trouble than it is worth. Both are wrong, as the Hippocratic maxim suggests. It is impossible to say in individual cases how much of the difference between the two experiences is due to placebo effects, to variations in the biologic makeup of the patients concerned, or simply to random chance.
KeywordsBone Mass Endometrial Cancer Increase Breast Cancer Risk Random Chance Endometrial Cancer Risk
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