Clearer Thinking with Spencer Greenberg Evidence-Based Medicine and its discontents (with Gordon Guyatt)
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Mar 5, 2025 
Gordon Guyatt, a Distinguished Professor at McMaster University and a pioneer in Evidence-Based Medicine, dives deep into critical healthcare topics. He explores how the EBM movement transformed patient care and modern medical practices. Guyatt addresses the influence of the pharmaceutical industry on treatment information and the importance of unbiased resources for doctors. He also discusses the complexities of patient-centered decision-making and the challenges posed by low-quality studies, particularly during the pandemic. Tune in for insights on navigating medical uncertainty and the evolving landscape of healthcare.
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Pre-EBM Decision-Making
- Before evidence-based medicine, treatment decisions relied on clinical experience, mentor advice, and physiological reasoning.
- This approach often proved misleading, as seen with antiarrhythmic drugs after heart attacks, which were later found to be harmful.
Misleading Treatments
- Antiarrhythmic drugs, initially thought helpful after heart attacks, were later found to increase mortality in randomized trials.
- Hormone replacement therapy, promoted for reducing heart attacks, was also found to potentially increase the risk.
Limitations of Biological Arguments
- Biological arguments for treatments, while seemingly logical, can be misleading due to the body's complexity.
- HDL, thought to protect against heart attacks, was raised by drugs like niacin and tracibs, but these proved ineffective.