Posted by Gary Schwitzer in Evidence-based medicine
Statins and clotbusting thrombolytics are two of the hottest selling drug classes.
But Dr, David Newman takes a closer look at each on his SMART Em blog (acronym for Scientific Medicine and Research Translation).
A few weeks ago, he wrote about statin drugs for low-risk patients, “Data, Drugs and Deception: A True Story.”
And then last week, he wrote, “Delusions of Benefit in the International Stroke Trial.” Excerpts:
Results of the largest and arguably most important trial ever of thrombolytics (clot-busting drugs) for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.
With advances in scientific literacy it has been years since I have seen a top journal allow authors to proclaim a conclusion in direct conflict with their own primary study results. And yet the authors blithely conclude that thrombolytics “improved functional outcome.” Worse, an accompanying editorial trumpets that “the role of stroke and emergency physicians is now not to identify patients who will be given rt-PA, but to identify the few who will not.” Welcome to Wonderland.
These statements feel not just forced, but frankly delusional. Has neuro gone psycho? The results of IST-3 indicate, at best, a profound disappointment (even the hallucinated benefit would be tinier than any previously claimed) and at worst the beginning of the end for thrombolytics in stroke. In either case, reality may be tough to handle, but it is not a matter of debate, or interpretation, or perception. The primary outcome failed. We have a phrase for that: no benefit.
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