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Feature Essay

Overcoming overuse: the way forward is not standing still—an essay by Steven Woloshin and Lisa M Schwartz

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2035 (Published 22 May 2018) Cite this as: BMJ 2018;361:k2035

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Re: Overcoming overuse: the way forward is not standing still—an essay by Steven Woloshin and Lisa M Schwartz

Dr Llewellyn makes the point that inadequate statistical methods have led to the misinterpretation of research findings. This, in turn, has led to the problem of overdiagnosis and overprescription. However, I would argue that it is not the RCT itself that is the problem, but the way that this has been implemented. Do not forget that it was the "gold standard" of research that led to the discovery of the link between Vitamin C and scurvy in the 18th Century [1]. Years later, a series of clinical trials [e.g. 2] found a link between retrolental fibroplasia (blindness in infants) and oxygen therapy. However, this finding was delayed for several years by nurses failing to adhere to trial protocol, i.e. administering oxygen to the control group, rather than the intervention group [3].

I would personally suggest that it is human error that is responsible for overtreatment, rather than statistical anomaly.

[1] Lind, J., 1757. A treatise on the scurvy: in three parts, containing an inquiry into the nature, causes, and cure, of that disease. A. Millar.

[2] Jonathan T. Lanman, M.D.; Loren P. Guy, M.D.; Joseph Dancis, M.D. 1954 RETROLENTAL FIBROPLASIA AND OXYGEN THERAPY JAMA. 1954;155(3):223-226. doi:10.1001/jama.1954.03690210001001 https://jamanetwork.com/journals/jama/article-abstract/317251

[3] Torgerson, D., 2008. Designing randomised trials in health, education and the social sciences: an introduction. Springer.

Competing interests: No competing interests

29 May 2018
Nicholas P. Hatton
Unemployed
Bromsgrove, Worcestershire