Moderate treatments effects: usual and not so obvious

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Stepwise progress doesn’t hit the headlines

Science itself works very badly as a news story: it is by its very nature a subject for the “features” section, because it does not generally move ahead by sudden, epoch-making breakthroughs. It moves ahead by gradually emergent themes and theories, supported by a raft of evidence from a number of different disciplines on a number of different explanatory levels. Yet the media remain obsessed with “new breakthroughs”.

Goldacre B. Bad Science. London: Fourth Estate, 2008, p219.

Most treatments do not have dramatic effects and fair tests are needed to assess them. And sometimes a treatment may have a dramatic effect in some circumstances but not in others.

Although vitamin B12 is undoubtedly effective for pernicious anaemia, dispute continues to this day about whether patients need quarterly or more frequent treatment. That question will only be answered by carefully controlled tests comparing the options.

Moreover, whereas the pain relief with hip replacements is dramatic, the relative merits of different types of artificial hip joints are far more subtle, but may nevertheless be important – some may wear out faster than others for example.

With laser treatment of portwine birthmarks, there is also still much to learn. Whilst this treatment remains the ‘gold standard’, research continues into why some lesions re-darken after several years, and on the effects of different types of lasers, possibly combined with cooling of the skin. [9], [10]

And while aspirin substantially reduces the risk of death in patients suffering a heart attack if given promptly on diagnosis, whether taking aspirin to prevent heart attacks and strokes does more harm than good depends on whether patients have underlying cardiovascular disease. The benefits – reduction in the risk of heart attacks, strokes, and death from cardiovascular causes – need to be balanced against the risks – bleeding, especially the type of stroke caused by bleeding into the brain, and bleeding from the gut. In patients who already have cardiovascular disease, the benefits of the drug greatly outweigh the risks. But in otherwise healthy people, the benefits of aspirin do not clearly outweigh the risk of bleeding. [11]