shovingitall's comments

Ahhh!! I mixed up my studies, that didn't happen in the PARADIGM-HF study. It has other limitations, but I was thinking of TOPCAT.

Physician here (intensive care, about 10 years of practice).

> It is simply no longer possible to believe much of the clinical research that is published

Absolutely agree. I've tried arguing this with colleagues—that we should be more careful about the clinical conclusions we draw from single studies—but I'm just met with resistance. We just added a new drug to the standard treatment of heart failure, based on a shady Novartis-funded study that decided, in a post-hoc analysis, to exclude something like 50% of the patients after-the-fact (and oh look! now we can show a mortality benefit!). It spits in the face of everything I've learned about the scientific method and clinical research. This is the PARADIGM-HF study and the drug is ENTRESTO in case anyone wants to look into it more. Caveat: it might be a beneficial drug for many patients.

> It is simply no longer possible...to rely on the judgment of trusted physicians or authoritative medical guidelines

I'm going to disagree with the author on this one. It is possible to trust and rely on your physician, and in many cases you have no choice. Guidelines are just that: guidelines. Not a replacement for careful thought. And I actually like the direction that many guidelines are adopting: one that brings more continual minor updates rather than infrequent major changes. This is a complicated discussion, and depends on what illness you have that leads to your interaction with our health care system, but my advice is to seek out doctors that seem to communicate well with you.