Re: Ob: Preterm labor
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Jan 29 16:13:59 2007
In a nutshell Joe - my point is that EBM without common sense makes no
sense at all...
Ef
>At Mon, 29 Jan 2007, DoctorJoe@aol.com wrote:
>
>In a message dated 1/29/2007 8:20:54 A.M. Central Standard Time,
>rkaplan@triad.rr.com writes:
>
>I am a believer in evidenced based medicine and I believe that "preterm
>labor" is overdiagnosed and overtreated. Having said that, I expect that we all
>have had that one patient with a 3 cm/effaced cervix, 0 station, who with
>hospitalization and/or terb. pump managed to carry the pregnancy to 36 weeks and
>delivered as soon as she got up and about or as soon as the pump was
>stopped. I guess I'm trying to say that just because it is hard to prove that
>tocolysis "works" statistically, that doesn't mean that it might still be
>beneficial in some select cases.
>
>Exactly. The main problem is, IMHO, the studies of preterm labor and
>tocolysis have to be rigorously designed to exclude (as best as can be done, at
>least) those false positive cases so as not to be studying overdiagnosed illness
>(i.e. NON illness). So if you look at the definition of "preterm labor" in
>most published studies, the patients included are often too far along in labor
>for anything to work very well anyway. I think all seasoned obstetricians
>would grant you that a patient in established labor at 4-5cm is NOT going to
>respond to tocolytic therapy. But you can't take people with a soft, 1cm cervix
>and contractions as part of the study, or you'll be overdiagnosing and
>overtreating, as you say. So the studies in the published literature (which show no
>benefit) are designed such that they WON'T show any benefit.
>
>So in day to day practice, you're left with treating people earlier in the
>process, hoping that your overtreatment of some people doesn't cause more
>trouble/expense than the benefit of catching those people that it helps.
>
>I guess this is a kind of medical macro application of the Heisenberg
>Uncertainty Principle. I think it applies to cerclage, as well. But that's another
>story for another day, although it may well be related.
>
>Joe P.
>
>"Chuck Norris is the reason why Waldo is hiding."
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
