Paul S. Phillips, MD
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Paul S. Phillips, MD, Scripps Mercy Hospital Catheterization Laboratories, 4077 5th Avenue, San Diego, CA 92103; e-mail, Phillips.Paul@scrippshealth.org.
Phillips PS. Balancing Randomized Trials With Anecdote. Ann Intern Med. 2009;150:885-886. doi: 10.7326/0003-4819-150-12-200906160-00014
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Published: Ann Intern Med. 2009;150(12):885-886.
Anecdotes may be misleading. They are uncontrolled. Findings may be due to chance, not cause and effect. The anecdote may incorrectly dissuade us from proven therapies. Dispassionate and objective, the randomized, controlled trial has rightfully gained priority as the highest level of evidence when selecting therapy for our patients. Its methodology minimizes the effects of bias and is responsible for medicine's progress from unproven treatments to the current era of evidence-based medicine. However, when it comes to drug toxicity, anecdotal case reports have repeatedly demonstrated that medicines previously found safe in randomized, controlled efficacy trials have important adverse effects (1). Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials. Our statin myopathy clinic, which now exceeds 600 patients (45 of whom have experienced statin-induced rhabdomyolysis), provides such an experience.
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Cardiology, Hospital Medicine, Dyslipidemia, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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