Tuesday, June 28, 2011

Medical system biases

A respectably sized randomized trial finds transcendental meditation has enormous effects on heart attack mortality, decreasing by half. Among the most vulnerable or the most involved in meditation, mortality decreased by 2/3rds. That would be huge even for a drug. As one of the study authors said, "The effect is as large or larger than major categories of drug treatment for cardiovascular disease."

Nonetheless, in spite of the much larger effect from meditation than any drug therapy, the article paraphrases the researchers as saying that the meditation should complement rather than replace drug treatment. If we believe that randomized trials yield correct information that can be used for treatment, why limit the results in this way?

Yes, the results need to be replicated a few times in different populations, etc., but my suspicion is that even after they are replicated (possibly with smaller effect sizes), the "don't stop taking drugs" message will remain.

Given recent results about increased risk of type 2 diabetes from statins and indications of memory problems from statins, those who advocate drugs need to defend their choice more. It seems that there's an implicit bias that treatment within the medical system must be healthier. Similar to the implicit bias against fat that caused Ancel Keys's views to prevail; now new studies that low-fat diets contribute to unhealthy weight gain are rarely publicized.

UPDATE: Now the article has been held back from publication due to last minute data, and the Telegraph took down the article. Wonder why.

1 comment:

Dan H said...

The telegraph link seems down. I found another reference that says the actual article is in the Archives of Internal medicine, but it doesn't seem to be on their website yet. I hold extreme skepticism of a newspaper article that very well might be misreading statistics to make a headline claim that's much more extreme than the authors. That's assume the study is actually well done.

Also, I think the drug/treatment biases no odd in this case. You're pointing to a single study vs decades of large-sample size studies of drugs. It's very possible the meditation + medication is even better than either separately.

You're also amplifying the statin risks. The risks have only been found with the highest doses of stating & I believe only simvastatin.