#17
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Ïîêàæèòå ìíå, ïîæàëóéñòà, ÐÊÈ, â êîòîðûõ èñïîëüçîâàëèñü íåêîììåð÷åñêèå ïðåïàðàòû.
 2004 ãîäó áûëî îïóáëèêîâàíî èññëåäîâàíèå ([Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]), àâòîðû êîòîðîãî îáíàðóæèëè, ÷òî â New England Journal of Medicine (NEJM) è Journal of the American Medical Association (JAMA), òî åñòü äâóõ èç íàèáîëåå àâòîðèòåòíûõ ìåäèöèíñêèõ èçäàíèÿõ, â 32% ñëó÷àåâ ïðèñóòñòâîâàë ñêðûòûé êîíôëèêò èíòåðåñîâ! Ïî ïîâîäó: Öèòàòà:
Âðÿä ëè ïîìîæåò - íå ðàâíî "îäíîçíà÷íî íå ïîìîæåò". Òåì íå ìåíåå, ïðèñóòñòâóþùèå äàþò îäíîçíà÷íûå ðåêîìåíäàöèè "íå óïîòðåáëÿòü". Áåç âñÿêîãî èíäèâèäóàëüíîãî ïîäõîäà. Âû æå ëþäåé ëå÷èòå, à íå êîãîðòû. Òàêîå îùóùåíèå, ÷òî ó âàñ âñå ïàöèåíòû "ñðåäíåñòàòèñòè÷åñêèå". Ãäå Âû îáíàðóæèëè ÏÐÎÂÎÊÀÖÈÎÍÍÛÅ ïðèäèðêè, ñîâåðøåííî íåïîíÿòíî. Êàê âîäèòñÿ â Ðîññèè, ïðèñóùèé âàì ìàêñèìàëèçì ïðåâðàòèë ÄÌ â ðåëèãèþ. |
#18
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Îáèæåíû íà Ðîññèþ? Òîãäà Âàì íå ñþäà. Âû íà÷àëè ýòó òåìó ñ öèòàòû, â êîòîðîé íå áûëî îäíîçíà÷íîé ðåêîìåíäàöèè "íå óïîòðåáëÿòü". Íå íàäî ïåðåäåðãèâàòü è çàíèìàòüñÿ äåìàãîãèåé.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#19
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Öèòàòà:
Âåäü ðåêîìåíäàöèè, êàê Âû ñïðàâåäëèâî çàìåòèëè, êàñàþòñÿ ñðåäíåñòàòèñòè÷åñêîãî áîëüíîãî, à äàííîìó êîíêðåòíîìó ðåáåíêó ìîãóò íå ïîìî÷ü.  èòîãå ïîëó÷àåì î÷åðåäíóþ æàëîáó íà âðà÷à, êîòîðûé íàçíà÷èë ëåêàðñòâî, êîòîðîå íå ïîìîãëî.  ïåäèàòðèè ïðàâèëî "íå ëå÷èòü âñå, ÷òî ìîæíî íå ëå÷èòü " îñîáåííî àêòóàëüíî. |
#20
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Ñïàñèáî áîëüøîå çà îáñóæäåíèå!
Âîò åùå èíòåðåñíàÿ ñòàòüÿ â [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "There is lots of individual-level experimentation in medicine," Dr. Hemilä explained. "For example, if a antihypertensive drug does not lower blood pressure in 1 person, we try another drug; we do not say that the lack of effect in 1 person is evidence that the first drug is ineffective in general. We say that it does not work for that particular person." "With similar kind of reasoning I think vitamin C may be tried for treating colds," Dr. Hemilä concluded. "If a person does not feel there is any benefit, he or she need not take it next time. But if vitamin C seems to be helpful, there is a subjective reason to try it again the next time." Another limitation is that essentially all the studies were performed in developed countries where the usual dietary intake of vitamin C is high. In terms of future research, Dr. Hemilä recommended well-planned therapeutic trials of vitamin C dosages well above 1 g/day, because some studies have suggested a dose-response effect with dosages up to 6 g/day. He also recommends a study duration of longer than 5 days, because a few 3-day therapeutic trials found no benefit, and he believes that the negative findings may have been caused by the short study duration. Åùå ðàç ýòî äàåò ïîâîä çàäóìàòüñÿ î òîì, ïî÷åìó äàííûå ÐÊÈ ïî ñîâåðøåííî äðóãèì ïîïóëÿöèÿì ñ òàêîé ëåãêîñòüþ ðàñïðîñòðàíÿþòñÿ îòå÷åñòâåííûìè äîêòîðàìè íà ñâîèõ ïàöèåíòîâ. Åñëè â èññëåäîâàíèÿõ ÷àñòîòà ïîáî÷íûõ ýôôåêòîâ áûëà òàêîé æå, êàê è â ïëàöåáî-ãðóïïàõ, ïî÷åìó òåì íå ìåíåå íå ïîïðîáîâàòü? Òåì áîëåå, ÷òî äëÿ àñêîðáèíîâîé êèñëîòû ïîêàçàíî íå òîëüêî "êëèíè÷åñêèå ñèìïòîìû ÎÐÂÈ èñ÷åçëè íà äåíü ðàíüøå", íî è óìåíüøåíèå òÿæåñòè ýòèõ ñèìïòîìîâ. Äëÿ Âàñ, êàê äëÿ äîêòîðà, ïåðåæèâàþùåãî î ñâîèõ ðèñêàõ, ýòî, ìîæåò áûòü, è íå âàæíî, à äëÿ ìîåãî "èíäèâèäóàëüíîãî" ðåáåíêà è ìåíÿ - âàæíî. |
#21
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Öèòàòà:
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#22
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Ïîãîäèòå ñ Ðîññèåé, äàâàéòå î âàøåì çàÿâëåíèè. Âû ïðîòèâîïîñòàâèëè ïîëîæåíèå èç ðåêîìåíäàöèé âðà÷åé ÐÌÑ ïîëîæåíèþ èç íåêà÷åñòâåííîé ñòàòüè ñ çàêàçíûìè èññëåäîâàíèÿìè. Âàì ïðîäåìîíñòðèðîâàíû î÷åâèäíûå ïðîìàõè â èññëåäîâàíèè. Êàêîâû Âàøè äàëüíåéøèå äåéñòâèÿ? ×òî Âû ëè÷íî æåëàëè áû óâèäåòü â ïðîäîëæåíèè òåìû? Çàäóìàéòåñü íàä îòâåòîì, òðîëëèíã áóäåò ïðåñå÷åí íåçàìåäëèòåëüíî è áåçæàëîñòíî.
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#23
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Óâàæàåìûé Âàñèëèé Þðüåâè÷!
 ïðîäîëæåíèè òåìû ÿ áû æåëàë, ÷òîáû Âû íàêîíåö-òî îáðàòèëè âíèìàíèå íà òî, ÷òî â ðÿäå èññëåäîâàíèé, "çàêàçàííîñòü" êîòîðûõ àáñîëþòíî íåî÷åâèäíà, áûëà ïîêàçàíà ýôôåêòèâíîñòü ýõèíàöåè è âèòàìèíà Ñ (ñì., íàïðèìåð, ïîñò ¹11 â ýòîé òåìå). È íåñìîòðÿ íà ýòî, ïîëíîñòüþ îòðèöàòü ýôôåêòèâíîñòü Ý. (ñ âèòàìèíîì Ñ âðîäå áû ðàçîáðàëèñü) - çíà÷èò âûáèðàòü óäîáíûå äëÿ ñåáÿ ïîçèöèè, èãíîðèðóÿ ðåçóëüòàòû íàó÷íûõ èññëåäîâàíèé. Êîõðàíîâñêèå áàçû äàííûõ - íå åäèíñòâåííûé äîñòîâåðíûé èñòî÷íèê. Ñóùåñòâóåò ìíîæåñòâî ïðåïàðàòîâ, äëÿ êîòîðûõ ÐÊÈ íèêîãäà íå ïðîâîäèëèñü, è òåì íå ìåíåå, îíè óñïåøíî èñïîëüçóþòñÿ â êëèíè÷åñêîé ïðàêòèêå. Ðàç óæ Âû îáâèíèëè ìåíÿ â òðîëëèíãå, õîòåëîñü áû óñëûøàòü ïðîñòûå îòâåòû íà ñëåäóþùèå âîïðîñû, ïîñëå ÷åãî òåìó ìîæíî çàêðûòü: Íåïîíÿòíà Âàøà ðåìàðêà íàñ÷åò "ðåêîìåíäàöèé âðà÷åé ÐÌÑ". Ýòî ÷òî, ïîñëåäíÿÿ èíñòàíöèÿ è èñòî÷íèê Èñòèíû? Íà ôîðóìå çàïðåùåíî ïðîòèâîïîñòàâëÿòü ðåêîìåíäàöèÿì âðà÷åé ÐÌÑ ñòàòüè èç èñòî÷íèêîâ ñ äîñòàòî÷íî âûñîêèì ÈÖ? Êàêèå ÐÊÈ, ïî-Âàøåìó, îïèñûâàþò "íå êîíêðåòíûå êîììåð÷åñêèå ïðåïàðàòû" (ñì. ïîñò ¹9)? Ïî÷åìó Âû çàêðûâàåòå òåìû (òåìà 154279), íå äîæäàâøèñü ðåàêöèè (óìîçðèòåëüíî ïðåäïîëîæó, ÷òî íàìåðåííî íå äîïóñêàÿ ðåàêöèè) âðà÷åé íà êîíêðåòíûé îòâåò (ïðî æàëîáû íà çåëåíûé öâåò êàëà, åñëè ïîçâîëèòå)? Ïîñëåäíèé âîïðîñ íå ñëó÷àåí: åñòü âîçìîæíîñòü, ÷òî Âû è ýòó òåìó çàêðîåòå äî çàâåðøåíèÿ å¸ îáñóæäåíèÿ. Ãàðàíòèðóåòå ëè Âû, ÷òî íåýôôåêòèâíîñòü Ý. è âèò.Ñ ó âñåé ÷åëîâå÷åñêîé ïîïóëÿöèè èëè òîëüêî ó ïàöèåíòîâ âðà÷åé ÐÌÑ áóäåò ïîäòâåðæäåíà ñ ðàçâèòèåì òàêîãî íàïðàâëåíèÿ, êàê ãåíîìíàÿ ìåäèöèíà (âñïîìíèì åùå ðàç, êàê ãåíîòèïèðîâàíèå âíåñëî î÷åâèäíûå benefits ïî ñðàâíåíèþ ñ evidence-based ðåêîìåíäàöèÿìè â ñëó÷àå ñ âàðôàðèíîì, íàïðèìåð)? Ñïàñèáî çàðàíåå çà îòâåò. |
#24
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1. Íåêà÷åñòâåííûé ïîäáîð ññûëîê.
2. Ðåêîìåíäàöèè àâòîðèçîâàííûõ âðà÷åé ÐÌÑ îñíîâàíû íà ïîñòîÿííîé ðàáîòå ñ ñîâðåìåííîé êà÷åñòâåííîé ëèòåðàòóðîé è æèâûìè ïàöèåíòàìè. Äëÿ ôîðóìà ÐÌÑ ðåêîìåíäàöèè ñîçäàþùèõ êîíòåíò âðà÷åé ÐÌÑ - èñòî÷íèê àâòîðèòåòà. Èñòèíà â äðóãîì ìåñòå, âû äîëæíû çíàòü. Íå ñòîèò ó÷èòü âðà÷åé ÐÌÑ æèçíè, âîîðóæàÿñü ïåðâûìè ïîïàâøèìèñÿ ññûëêàìè. Àíãëèéñêèé ÿçûê è ñëîâî "ÐÊÈ" íå ãàðàíòèðóåò êà÷åñòâà. 3. ß çàêðûâàþ òåìû, ò.ê. ÿ ìîäåðàòîð â ýòîì ðàçäåëå. ß îöåíèâàþ êà÷åñòâî ïóáëèêàöèé è âìåíÿåìîñòü ó÷àñòíèêîâ, äàþùèõ ðåêîìåíäàöèè. Æåëàþùèå îñïîðèòü äåéñòâèÿ ìîäåðàòîðîâ ïèøóò ïèñüìà àäìèíó. Æåëàþùèå äåëàòü ýòî ïóáëè÷íî îòïðàâëÿþòñÿ â áàí, êóäà Âû ñåé÷àñ è ïðîñëåäóåòå. 4. Ãàðàíòèðîâàòü ÷òî-ëèáî ìîãóò â ìàãàçèíå. Íà ôîðóìå ÐÌÑ âûáèðàþòñÿ îïòèìàëüíûå ðåêîìåíäàöèè äëÿ ïàöèåíòîâ, èñõîäÿ èç ñóùåñòâóþùèõ îïóáëèêîâàííûõ äàííûõ. Ïîïûòêè íàóêîîáðàçíîãî ôëóäà ïðåñåêàþòñÿ â ñâÿçè ñ ïîòåíöèàëüíîé îïàñíîñòüþ äëÿ ÷èòàþùèõ íåñïåöèàëèñòîâ. 5. Òåìà çàêðûâàåòñÿ, èáî áåçãðàìîòíûé ôëóä. |