Healthy Skepticism Library item: 11428

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Hébert PC, Stanbrook M.
Indication creep: physician beware
CMAJ 2007 Sep 6; epub ahead of print
http://www.cmaj.ca/cgi/rapidpdf/cmaj.071223

Abstract:

This issue of CMAJ features a systematic review (page 725) of the use in critically ill patients of erythropoietin, a drug that is widely promoted without an approved indication in this patient population.1 Erythropoietin, a complex recombinant glycoprotein hormone, is approved for the treatment of anemia in patients on dialysis, in patients who have had major surgery or in patients undergoing cancer care. The systematic review highlights the finding that when this treatment, which costs about $400 per dose, is used offlabel for critically ill patients, it will save, on average, less than 1 unit of blood, will not improve clinical outcomes and will potentially result in more thrombotic complications…

Notes:

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909