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Sunday, July 4, 2010

Evidenced Based Medicine's Pitfall

Failure. The word failure is my son's new child-acceptable expletive, taking presidency over the word "snap" used extensively last year. My 10-year old son uses this word repeatedly throughout the day when things just don't come out as expected or there is a serious breakdown or injury on America's Funniest Home Video show. Anyway, I can't think of a more appropriate word than "failure" when it comes to a study published in the Cochrane Reviews on June 16, 2010.

Cabello JB, Burls A, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007160. DOI: 10.1002/14651858.CD007160.pub2 is a trial which studied O2 therapy in AMI patients and had a unusual conclusion: There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.

WHAT? FAILURE? This is so counter intuitive, I mean in my 17-year EM career O2 therapy is the mainstay and initial therapeutic used for our "chest pain" complaint patients and for years and hundreds of examples, I was witness to its ameliorating effects. Now some online journal is telling me otherwise? What gives? Well the authors are quick to point out that a large trial(s) needs to be performed to further evaluate this report. In this small study (n=387) 14 patients died and three times the number of fatalities occurred in those receiving oxygen therapy. There are probably a number of confounding factors that resulted in the outcome as it is. Here is one shining example of recent reports of how "evidence based medicine" (EBM) practice is flawed. Caveat Emptor! Anyone who buys into the 100% undeniable and infallibility of EBM needs to beware.


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