Posts Tagged ‘evidence’

h1

The Little Superstitions of Nurses

May 25, 2010

By Marcy Phipps, RN 

The first time I took care of a really sick patient in the ICU I was terrified. I didn’t fully trust my skills or instincts and often consulted with the experienced nurses around me. I was surprised when one long-time nurse suggested that tying a knot in a corner of the bed sheet would keep my patient from dying, at least during my shift. But I tried it. After all, what did I have to lose?

I was greatly relieved when my patient made it through the day. It seemed absurd that a knotted bed sheet could have any effect on life or death, but I didn’t entirely dismiss it—at least on some level.

The nurses I work with don’t discuss superstition any more openly than they discuss spirituality or religion. Most of us, however, have certain notions that we recognize and quietly adhere to.  Not a single one of us will say that it’s a “quiet day.” Nobody will pick up a Sunday paper on the way to work. No matter how difficult our assignment, very few of us will change assignments in the middle of consecutive shifts. Putting a chart together in anticipation of an admission is known to result in the admission being reassigned, and a code cart parked near an unstable patient is acknowledged to “ward off evil spirits.”

I would describe my fellow ICU nurses as scientists. We dislike ambiguity and are most comfortable in the presence of clear evidence, concrete numbers, and calculations. Even so, we hold onto our superstitions. Maybe we’re being silly, but perhaps we are acknowledging (or hoping) that there’s more to life than science.

Marcy Phipps is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN.

 

Bookmark and Share

h1

And You Thought PE Was Another Name for Gym Class

December 14, 2009

By Jacob Molyneux, senior editor

The template goes something like this: Start with a legitimate quality-of-life issue — like fitful sleep or shyness — that does not yet have its own prescription medication and is debilitating to a few people a lot of the time. Next, position the quality-of-life issue as a medical condition with symptoms so common it covers vast numbers of people who had previously not identified themselves as having a health problem, or who thought they were just experiencing an occasional and normal annoyance.

According to the rest of this article in the NY Times, the latest disorder about to enter our dictionary of accepted medical conditions is premature ejaculation (PE). Several companies are developing treatments in the form of pills or aerosol sprays. The net of nonspecific symptoms seems to have been cast fairly wide—a representative of one drug company is quoted as saying that one in three men have this condition. 

Celebrities may soon be confessing that the anxiety occasioned by PE has led to ruined marriages, depression, drug use, and even the use of prostitutes. The ironies of the media campaign to push the term PE into our medical lexicon are worth considering as our legislators debate health care reform provisions and the crisis of rising costs. Medical bankruptcy is on the rise. Many cannot afford medications they need for serious conditions like heart disease and diabetes.

It may be premature to suggest it, but it seems likely the pharmaceutical companies expect health care reform legislation to result in few new limitations on their ability to direct market their drugs to consumers, to create markets for conditions that formerly didn’t exist, and to create a whole body of ghostwritten literature that can be cited as evidence.

Bookmark and Share

h1

Why Don’t Drug Labels Make the Actual Harms and Benefits Clear?

October 22, 2009

By Jacob Molyneux, blog editor/senior editor

How can we know if a drug really works? Gary Schwitzer, publisher of HealthNewsReview.org (an incisive Website that grades the quality of health news reporting) addresses this question on his blog this week by drawing attention to a recent perspective piece published in the New England Journal of Medicine (NEJM). It’s called “Lost in Transmission — FDA Drug Information That Never Reaches Clinicians” and it states the problem clearly:

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated — and relatively little would be needed — to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.

The most direct way that the FDA communicates the prescribing information that clinicians need is through the drug label. Labels, the package inserts that come with medications, are reprinted in the Physicians’ Desk Reference and excerpted in electronic references. To ensure that labels do not exaggerate benefits or play down harms, Congress might have required that the FDA or another disinterested party write them. But it did not. Drug labels are written by drug companies, then negotiated and approved by the FDA.

One example given in the NEJM article is the sleeping pill Lunesta:

Clinicians who are interested in (Lunesta’s) efficacy cannot find efficacy information in the label: it states only that Lunesta is superior to placebo. The FDA’s medical review provides efficacy data, albeit not until page 306 of the 403-page document. In the longest, largest phase 3 trial, patients in the Lunesta group reported falling asleep an average of 15 minutes faster and sleeping an average of 37 minutes longer than those in the placebo group. However, on average, Lunesta patients still met criteria for insomnia and reported no clinically meaningful improvement in next-day alertness or functioning.

What is the real benefit of a particular drug? You may not find it in the label.

FDA approval does not mean that a drug works well; it means only that the agency deemed its benefits to outweigh its harms. Read the rest of this entry ?

Follow

Get every new post delivered to your Inbox.

Join 258 other followers