For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2

Reasoning and Evidence-Based Medicine: Common Pitfalls

Jai Varma, MD, Rechell Rodriguez, MD, FACP, Ishak A. Mansi, MD, FACP
Volume: 105 Issue: 3 March, 2012

Abstract:

It is impossible to answer every potential clinical question through randomized controlled trials. Hence, assumptions, rational thinking, logic, and reasoning are used in making recommendations; however, these methods may interfere with the judicious application of evidence-based medicine and, as discussed in this article, may result in logical fallacies. We also explain how we may incorporate recommendations based on assumptions and rational thinking in patient care. Extrapolations of study content and confusing association with causation are common pitfalls in the application of the evidence-based medicine process. Personal bias can be another barrier in the adoption of evidence-based medicine. It can be difficult to modify personal bias despite the evidence; keeping up with the medical literature in a busy practice can be daunting.

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

1. Mansi I, Huang J, Carden D. Pharmacologic treatment of chronic systolic heart failure: past, present, and future. Adv Stud Med 2005; 5: 81–89.
 
2. Pignone M, Alberts MJ, Colwell JA, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes. J Am Coll Cardiol 2010; 55: 2878–2886.
 
3. Steinberg D. Earlier intervention in the management of hypercholesterolemia: what are we waiting for? J Am Coll Cardiol 2010; 56: 627–629.
 
4. Forrester JS. Redefining normal low-density lipoprotein cholesterol: a strategy to unseat coronary disease as the nation’s leading killer. J Am Coll Cardiol 2010; 56: 630–636.
 
5. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2007; 30: 162–172.
 
6. Pignone M, Alberts MJ, Colwell JA, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation 2010; 121: 2694–2701.
 
7. Cohn JN, Rector TS. Prognosis of congestive heart failure and predictors of mortality. Am J Cardiol 1988; 62: 25A–30A.
 
8. Effects of encainide, flecainide, imipramine and moricizine on ventricular arrhythmias during the year after acute myocardial infarction: the CAPS. The Cardiac Arrhythmia Pilot Study (CAPS) Investigators. Am J Cardiol 1988; 61: 501–509.
 
9. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med 1989; 321: 406–412.
 
10. Mehra MR, Uber PA, Francis GS. Heart failure therapy at a crossroad: are there limits to the neurohormonal model? J Am Coll Cardiol 2003; 41: 1606–1610.
 
11. Messerli FH. The sudden demise of dual renin-angiotensin system blockade or the soft science of the surrogate end point. J Am Coll Cardiol 2009; 53: 468–470.
 
12. Nelson HS, Weiss ST, Bleecker ER, et al. The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006; 129: 15–26.
 
13. Cazzola M, Matera MG. Safety of long-acting beta2-agonists in the treatment of asthma. Ther Adv Respir Dis 2007; 1: 35–46.
 
14. FDA Drug Safety Communication. New safety requirements for long-acting inhaled asthma medications called long-acting beta-agonists (LABAs). http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm200776.htm. Published February 18, 2010. Accessed January 10, 2011.
 
15. Parving HH, Persson F, Lewis JB, et al. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 2008; 358: 2433–2446.
 
16. Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008; 372: 547–553.
 
17. Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357: 2109–2122.
 
18. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–412.
 
19. Fairman KA, Curtiss FR. Still looking for health outcomes in all the wrong places? Misinterpreted observational evidence, medication adherence promotion, and value-based insurance design. J Manag Care Pharm 2009; 15: 501–507.
 
20. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560–2572.
 
21. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559.
 
22. Dormuth CR, Patrick AR, Shrank WH, et al. Statin adherence and risk of accidents: a cautionary tale. Circulation 2009; 119: 2051–2057.
 
23. Gronseth GS. From evidence to action. NeuroRx 2004; 1: 331–340.
 
24. Gutteridge JM, Halliwell B. Antioxidants: molecules, medicines, and myths. Biochem Biophys Res Commun 2010; 393: 561–564.
 
25. Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med 2006; 145: 372–385.
 
26. Schiff AF. Some musings on the reliability of statistics. South Med J 1992; 85: 229–230.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions