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J Askins's avatar

Excellent post, John. Your last paragraph reminds me of a short letter to the editor of the BMJ written by Dr. David Sackett who is considered the “father of evidence based medicine”. The 1996 letter was in response to criticism of EBM and is titled “Evidence based medicine: what it is and what it isn’t”. It is a short one page letter and worth reading from time to time. One notable quote, of which there are many, from the article: “Any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thus whether it should be applied. Clinicians who fear top down cookbooks will find the advocates of evidence based medicine joining them at the barricades.” Dr Sackett’s concerns in the letter were prescient as to how EBM has been hijacked by financial managers, political activists, and Big Pharma.

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Matt Cook's avatar

I’m not sure that evidence-based medicine makes any sense, John.

The problem is, that it requires explanatory theories first, and that is often ignored. Studies are done that get financed by Big Pharma largely. There are some that are done without that funding, and there are some older studies that were done before the massive corruption.

But for example, for heart failure, I am convinced that small amounts of T3 can reverse HF. Yet the studies aren’t really done because there is no money in that, and no explanatory theories that are currently in vogue supporting it.

There is certainly evidence for decades that raising T3 is the solution to HF. For instance several studies showed risk of death higher with lower T3.

https://www.sciencedirect.com/science/article/abs/pii/S0002934304006576

All-cause mortality was 23% (n = 64) after a mean (±SD) of 12 ± 7 months of follow-up; 47 (73%) of the patients died from cardiac causes. The mean ejection fraction was lower in those patients who died than in those who survived (26% ± 8% vs. 31% ± 8%, P < 0.001), as were levels of total T3 (1.0 ± 0.4 nmol/L vs. 1.3 ± 0.3 nmol/L, P < 0.001) and free T3 (3.2 ± 1.4 pmol/L vs. 3.7 ± 1.0 pmol/L, P < 0.001). In a multivariate model, ejection fraction (odds ratio [OR] = 2.0 per 10% decrease; 95% confidence interval [CI]: 1.4 to 2.8 per 10% decrease; P < 0.001) and total T3 level (OR = 0.3 per 1-nmol/L increase; 95% CI: 0.1 to 0.5 per 1-nmol/L increase; P < 0.001) were the only independent predictors of all-cause mortality. In an alternative model using free T3 levels, ejection fraction (OR = 1.9; 95% CI: 1.4 to 2.7; P < 0.001) and free T3 level (OR = 0.6 per 1 pmol/L; 95% CI: 0.5 to 0.8 per 1 pmol/L; P <0.02) were associated with all-cause mortality. When we considered cardiac mortality alone, male sex (OR = 3.5; 95% CI: 1.7 to 13; P < 0.04), ejection fraction (OR = 1.7; 95% CI: 1.2 to 2.5; P < 0.006), and total T3 level (OR = 0.3; 95% CI: 0.2 to 0.7; P < 0.002) were independent predictors with the multivariate model.

Conclusion

Low T3 levels are an independent predictor of mortality in patients with chronic heart failure, adding prognostic information to conventional clinical and functional cardiac parameters.

——

It’s safe

https://www.sciencedirect.com/science/article/abs/pii/S0002914997009508

And it works

https://www.ingentaconnect.com/content/ben/prc/2008/00000003/00000001/art00003

And yet, there are virtually no doctors who pay any attention to this. HF is a result of very low cellular energetics and often accomplices type 2 diabetes and other metabolic issues that come from high fat burning, minimal oxidative phosphorylation, high glycolysis producing lactate, high build up of lactate…

The explanatory theory would suggest, let’s give patients small doses of T3 and get their cellular energetics back up. And it works. But nobody is doing it, nobody talks about it, because the “evidence” isn’t there because Big Pharma doesn’t want the evidence to be there.

That’s the problem with the “evidence based” approach.

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