DWQA Questions › Tag: British Medical Journal
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We have shared comments about the paper in JAMA blowing the whistle on medical dangers, in pointing out that the U.S. healthcare system was the third leading cause of death in America (Starfield, B. Is US health really the best in the world? JAMA 2000 284:483-5). Things continue to raise questions. I just saw a citation of an editorial by Richard Horton, editor of The Lancet, one of the world’s top medical journals, published in 2015 in which he says: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” While this is largely focused on the pressures to publish because of the vested interests of researchers, as well as journal editors, is there a deeper reason that quality and integrity suffer?
ClosedNicola asked 4 days ago • 
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A viewer asks: “High blood pressure is conventionally regarded as a health risk and that lowering it reduces risk, especially in moderate-to-severe systolic BP of 140-159 mmHg. Dr. Malcolm Kendrick author of Doctoring Data claims that cardiovascular risk increases more steeply after systolic BP reaches around 160-170 mmHg—well beyond the 140/90 threshold often used to diagnose and treat hypertension. A rule of thumb in medicine is that for older individuals, a systolic BP of around 100 + age is a reasonable upper limit beyond which cardiovascular risks increase significantly. Is hypertension over-treated, given that aggressively lowering blood pressure—especially in older individuals—can be harmful?”
ClosedNicola asked 2 months ago • 
143 views0 answers0 votes
A viewer asks: “A 2018 book, Medical Nihilism, by Jacob Stegenga claims the healthcare system over-adopts treatments and under-recognizes risks. He states confidence in the effectiveness of medical interventions should be low because empirical evidence for the efficacy of many treatments is weak due to methodological flaws, publication bias, the influence of commercial interests. He claims positive studies are more likely to be published, screening programs tend to detect and treat cancers that would never cause harm, common treatments can cause long-term complications, short trial durations miss long-term harms etc. How accurate is his view that evidence is systematically skewed and harms are undercounted?”
ClosedNicola asked 2 months ago • 
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A viewer asks: “Dr. Bernard Lown, a Harvard cardiologist in the 1980s, criticized the rapid rise of surgical Coronary Artery Bypass Grafts (CABG), noting 20–40% were potentially avoidable, especially in stable angina, and many patients had uncertain survival benefit. He advocated medical therapy—nitrates, beta-blockers, lifestyle changes—for symptom control. How accurate is it to say that in 2026, evidence-based guidelines and trials have reduced avoidable CABG to <10% for high-risk, guideline-selected patients, and that for low-risk, stable patients, surgery rarely improves survival, and that beta-blockers, nitrates, ACE inhibitors, lifestyle changes are to be preferred?”
ClosedNicola asked 2 months ago • 
114 views0 answers0 votes
A viewer asks: “A 2012 paper in the British Medical Journal “Use of relative and absolute effect measures in reporting health inequalities” concluded that “75% (258/344) [of 2009 papers] reported only relative effect measures.” Absolute risk reduction is often far less impressive and less often stated. This suggests that physicians will overestimate the efficacy of treatments and patients may have a misplaced belief in both effectiveness and risks. To what extent does this practice mislead patients and clinicians and benefit pharmaceutical manufacturers?”
ClosedNicola asked 3 months ago • 
71 views0 answers0 votes
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