BReINThis article (Is back pain and stiff shoulders a red flag for cancer?)I talked about not being deceived by the magic of numbers. in the first placeThe idea of probability and statistics is a vital and essential aspect of all medicine.
In Japan, medicine is generally considered to be a symbol of science. However, when we study the history of medicine, we see a slightly different side.
A few decades ago, Finnish health authorities conducted the following experiment to find out how effective health checkups and health guidance are.
First, we selected 1,200 managers aged 40 to 45 who had risk factors for cardiovascular disease. Divide it into two groups by lottery, and for one of the 600 peopleInstruct daily exercise and refrain from smoking, drinking alcohol, and consuming sugarprovide regular health checkups and nutritional surveys, and if necessaryadminister medication. What about the other 600?Left without implementing health managementDid.
this experimentAfter 15 years, comparing both groups, a clear difference emerged. One group had fewer heart and vascular disease, deaths, and suicides. Oh my God, itpeople without health carewas. It seems that doctors who were shocked by this fact refrained from publishing the results of the experiment.
The following is a story from England in the 1970s. At that time, the method of using multiple types of anticancer drugs in small doses for patients with inoperable lung cancer was widespread among specialists.Highly effective with few side effectsbecause it was thought
At one point, some researchers conducted the following experiment to evaluate the effectiveness of this treatment. For 188 similar patients, "4 types of anticancer drugs""use only one""do not useWe divided the patients into three groups, and compared their subsequent progress.
Surprisingly, it turned out that the group that did not use anticancer drugs had the best treatment results, and the group that used four anticancer drugs had the worst results.
Today, medicine is facing a major turning point. While spectacular technological innovations such as human genome analysis and nanotechnology are progressing, behind the scenesSteady work is underway to review the conventional medical policy.
BReINEvidence-based medicine, abbreviated as EBM, is a project to re-verify the validity of tests and the effectiveness of treatments that are taken for granted.
The most important experimental formats in EBM are:
First, we gather as many patients as possible for the experiment and divide them into two groups at random (in some cases, evenly distributing gender, age, occupation, family history, etc. to eliminate bias in individual distribution).
One group will receive treatment A, the other group will receive treatment B, and follow-up.
If the experimental subject concerns medication,real medicineWhenplaceboofEach group is given a dose, and neither the patient nor their doctor knows which drug they are being given. Finally, follow-up results will be compared between the two groups, and medical statistics will be used to determine efficacy.
What is the hidden meaning of this type of experiment – comparative testing?
that isto eliminate the placebo (or placebo) effect. Is it due to the “placebo effect” (a phenomenon in which symptoms improve due to psychological beliefs) that symptoms improve even when you take a placebo (a tablet made of sucrose or starch that has no effect), or is it really the drug? It's an experiment to find out if it's the effect of the ingredients.
In general, 40 to 60% of the people in the group who took the placebo also recovered, so when comparing the improvement rate with the group who took the real drug, the latter number was significantly higher. If it becomes clear, then"The effect of the medicine is real』It is judged.
This kind of experimental methodRandomized controlled trial(Randomized controlled trial: RCT).
At EBM, a third-party organization collects and analyzes RCTs conducted around the world on a single theme and publishes the results. Such information is regularly updated and published on the Internet and in books.
Based on this data, guidelines for each disease are created, and doctors in the field help determine treatment policies. In addition to RCTs, the following studies are also being conducted at EBM.
■ Case-control studies
A retrospective comparison of risk factors in a group of patients who have already developed a disease or condition with those who have not. For example, the lifestyle habits (Smoking status, amount, exercise, diet, etc.) to compare risk factors in
■ Cohort study (prospective)
It is to observe how a group of "risk factors for developing a disease" that has been investigated in advance develops after that. For example, we will follow up how a group of heavy smokers develops lung cancer, or how an obese group develops lifestyle-related diseases.
■ Cohort study (retrospective)
What kind of condition (Work/Environment/Nutrition/Exercise). For example, how people who had a stroke lived in the past.
■ Cross-sectional research
for exampleRelationship between low back pain and diagnostic imagingWhen investigating , 100 patients with low back pain and 100 healthy subjects will be collected, their X-ray, CT, and MRI photographs will be compared, and the results will be analyzed.
Cohort studies are basically used for large-scale epidemiological studies (tens of thousands to hundreds of thousands of people), while cross-sectional studies are based on fixed-point observations on the time axis or data collection over a short period of time, and are mainly used for diagnostic methods. used in relation to..
BReINThe shocking data published in the 1990s that ``the cause of 85% in low back pain is unknown'' is famous as the result of cross-sectional research on diagnostic imaging.
For your reference, in knowing the transformation of medical care by EBM,Let me give you the most familiar example.. The relationship between colds and antibiotics. Antibiotics are drugs that kill bacteria (Antibacterial drug), so it is ineffective against viruses. Eighty to ninety percent of colds are caused by viruses, so antibiotics are not effective against common colds.
So why is it often prescribed for colds? In Japan, it is used to prevent secondary infections such as pneumonia. However, with EBMNo protection against secondary infectionsBecause it turned out thatAntibiotics are not prescribed for colds in the West..
In Japan as well, the Japanese Respiratory Society has announced guidelines based on EBM, warning against relying on antibiotics easily...
As for influenza, if it is not as strong as a pandemic is expected, "rest at home" is common sense in Europe, and there is no custom of relying on antiviral drugs prescribed by doctors (such as Tamiflu).
Japan is said to be the world's largest consumer of antibiotics.
The best way to change the "antibiotic-dependent society" is for each and every one of us to learn how to be truly healthy, and acquire the wisdom to strengthen the immune function - a lifestyle that activates immune cells. Is it not?
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In the current situation where image labeling and diagnosis of the cause of pain diverge, the International Association for the Study of Pain (IASP) has revised the definition of pain and is shifting to the "emotional origin theory of pain."
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