Medical Myths

Evidence-Based Medicine for Student Health Services
Robert J. Flaherty, MD
Swingle Student Health Service
Montana State University
Bozeman, MT 59717 Medical Myths
http://www.montana.edu/wwwebm/myths.htm

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Here is an example
. Myth: The United Kingdom Prospective Diabetes Study (UKPDS) of 5000+ patients followed over 20 years, showed:
a. Hyperglycemia in Type II diabetes is a continuous, modifiable risk factor for clinically important outcomes and that reduction in glucose is the key to improving outcomes
b. Tight blood glucose control is an important goal in Type II diabetes
c. Intensive treatment of Type II diabetes is beneficial

7. Reality: A closer and more objective look at the UKPDS data clearly shows:
a. The medications used (glibenclamide, chlorpropamide and/or insulin) to lower blood glucose concentrations produced no significant benefit on any single macrovascular end point for any group of patients
b. Metformin reduced progression of retinopathy and reduced the frequency of the aggregated diabetes-related endpoints, all cause mortality, and stroke compared with the sulphonylureas and insulin or diet alone
c. The benefit of metformin is not necessarily related to its hypoglycemic effect
d. Decreasing HgbA1c using medication did not improve any clinical endpoint

WHAT DO YOU MAKE OF THIS????

McCormack J, Greenhalgh T, Seeing what you want to see in randomised controlled trials: versions and perversions of UKPDS data, BMJ 2000 June 24, 320:1720-3. PMID: 10864554
Shaughnessy AF, Slawson DC. What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes. BMJ 2003 Aug 2; 327(7409): 266. PMID: 10864554