I believe this is one reason endocrinologist dont take up EBM, because knowledge of mechanism differentiates them from internists. Focus on outcomes that matter to patients reduce the value of that difference.
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How will doctors deliver “careful and kind care” after their Grand Rounds have debunked them as unthinking transistors switched deterministically by EBM guidelines? [Source:
#KarlPopper’s “Realism & the Aim of Science” §33 pp. 258-9]pic.twitter.com/bSRdq7QeyD
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mechanism of action is the focus of all quackery
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One of my wise senior oncology colleagues, Rich Stone, says “There is virtually no drug for which someone can’t make up a story about how one of its proposed mechanisms of action means it will work in your tumor of interest - so take all that with a grain of salt”.
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Perfect. It's like explaining why the market fell, after it has fallen.
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I hate this idea. Mechanisms of action aren't just hand wavy explanations of effect, they let us know/predict side effects, drug interactions, and class effects. We can't do an RCT to answer all of the relevant questions to prescribe.
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Not my point. If you are talking about drug development, give me 60 minutes on mechanisms. If you are telling me how I should treat a patient, spend time on the data that proves that something works rather than on an explanation of why it might work.
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No. In epilepsy, mechanism of action is absolutely necessary not only due to different mechanisms having different efficacy on different types of epilepsy, but also due to frequent need for polypharmacy for intractable epilepsy and to make sure different meds play well together
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Not to me snarky but: I imagine you have never had a clinical outcome that you did not predict based on your understanding of the mechanism of action of the drugs...
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