It certainly looks unseemly when the champions for this device were paid by the manufacturers to use it, absent evidence of benefit.
This trial does not absolve the early adopters. They were “right”, for all the wrong reasons. In that way, no better than a broken clock being “right” twice a day.
And even so, this trial showed some benefit in a highly selected population, at significant cost beyond the monetary aspect. In an ideal “honest” world, this should actually decrease utilization. But this being the real world…
And it’s only one trial, so it’s still possible that the perceived advantage was a matter of random chance.
The trouble with this, and with drugs, is that the doctors prescribing the intervention in the real world stray from the patient selection criteria (and hence what was proven) in the research, so the intervention ends up being used more than it ought to be, with even less benefit (and more harms). If you use it in somebody who didn’t need it (because they would have recovered anyway) and they get better (as they would have done regardless), then you can easily convince yourself that the intervention “worked”, and you’ll be inclined to do it again. Conversely, if you use it in somebody who was going to die anyway, and they die regardless, then you can easily convince yourself that you “tried everything”, and you’ll do it again.
It certainly looks unseemly when the champions for this device were paid by the manufacturers to use it, absent evidence of benefit.
This trial does not absolve the early adopters. They were “right”, for all the wrong reasons. In that way, no better than a broken clock being “right” twice a day.
And even so, this trial showed some benefit in a highly selected population, at significant cost beyond the monetary aspect. In an ideal “honest” world, this should actually decrease utilization. But this being the real world…
Your thesis is that usage shouldn’t increase much. I agree. It shouldn’t.nonetheless, my thesis is that it will.
And it’s only one trial, so it’s still possible that the perceived advantage was a matter of random chance.
The trouble with this, and with drugs, is that the doctors prescribing the intervention in the real world stray from the patient selection criteria (and hence what was proven) in the research, so the intervention ends up being used more than it ought to be, with even less benefit (and more harms). If you use it in somebody who didn’t need it (because they would have recovered anyway) and they get better (as they would have done regardless), then you can easily convince yourself that the intervention “worked”, and you’ll be inclined to do it again. Conversely, if you use it in somebody who was going to die anyway, and they die regardless, then you can easily convince yourself that you “tried everything”, and you’ll do it again.
“ We do it for drugs, …”
Don’t think so, not anymore.