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OB: progesterone - reponse to Peter Wein! From: Malcolm Griffiths (Malcolm@MGRIFF22.demon.co.uk) Sun Jun 28 03:16:27 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Malcolm Griffiths: "Re: +3/5" Previous message: Gary Kleinman: "Re: win98 upgrade" In reply to: Peter Wein: "Re: OB: progesterone" Next in thread: Richard Chudacoff, MD: "Re: OB: progesterone" In message <199806280507.PAA07381@ariel.ucs.unimelb.EDU.AU>, Peter Wein <p.wein@obsgyn-mercy.unimelb.EDU.AU> writes >> > >Malcolm - your words were "There is no proven benefit of prog >supplementation at all outside of >assisted conception. Any use otherwise is at best placebo and at worst >quack!" - you didn't;mention anything about recurrent miscarriage This is getting pedantic. I think one must always reflect on what is said and meant by the context. Of course there are roles for progesterone - it is a vital component of many contraceptive regimes, opposed HRT and may be beneficial in uterine bleeding problems!!! >- nor was >this the topic of the original post. I would submit that there is some >proven benefit of prog supplementation - be it in avoiding preterm births >and requiring multiple injections and all - and just looking at 95% >confidence interval is being blinded by statistics - all they mean is that >we are 95% sure that the true OR lies within the stated range - but if >there is a benefit - do we have to be that sure - in the civil courts all >we have to be is more than 50% sure! > In most legal jurisdictions (including Australia I think!) the first element of negligence litigation is to establish substandard care. Only if care falls below an acceptable standard does the process move on to decide whether on the balance of probabilities (your >50%) that a different management would likely have resulted in a different outcome. If one wanted to link this to OR's I think it would actually be more appropriate to link it to ARR (absolute risk reduction). An intervention might show a OR of 2, even in this example - treatment A leads to only one death in 100, compared to treatment B, which has 2 deaths in 100. OR is 2. However 99/100 patients treated will do just as well/badly with treatment A as with B. If I've done the sums right the ARR is 1/100. Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997]) Next message: Malcolm Griffiths: "Re: +3/5" Previous message: Gary Kleinman: "Re: win98 upgrade" In reply to: Peter Wein: "Re: OB: progesterone" Next in thread: Richard Chudacoff, MD: "Re: OB: progesterone"

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