Re: Phuong Lien & Evidence-based medicine

["DiemQuynh Nguyen" <diemquynhng@hotmail.com>]

 Dear anh Tuan(USW) et al:
 DQ: Anh Tuan call me, therefore, I have to present my opinions as 
below.

 
>Dear anh Huy and friends,
>
>	Your comments remind me of an article I wrote in the 
>local paper  here last year on the issue of Evidence-based 
>Medicine (EBM), which I am sure you are aware of. In fact, 
>yesterday, the issue is on again in the national newspaper. 
>
>	For those of you who are not familiar with this 
>concept, let me provide you a brief summary. In the old days, 
>medicine was taught by experts in a black-and-white manner; 
>that is, when the expert says X causes disease Y, you just 
>have to listen to him/her. Full stop! These fellows were also 
>very powerful in setting the research direction, and of 
>course, funding. These days, medicine, just like any other 
>discipline, is a matter of knowledge and probability. And, 
>knowledge is power. EBM is an idea of combining all available 
>knowledge (as published in medical journals) to arrive at the 
>best possible treatment. The statistical process of combining 
>evidences from published papers is called META ANALYSIS. 
>Thus, if you want to know whether mobile phone is DEFINITELY 
>associated with cancer, you can go to search for, say, 1000 
>papers (some of which conclude yes, other conclude no) in 
>medical literature and combine the results to arrive at the 
>answer of yes/no.
>
>	Back to anh Huy's comments. While there is no problem 
>whatsoever on the use of synthesis of research evidence to 
>search for the best treatment in public health, there is 
>problem in applying this concept to an individual. On the 
>average, the survival rate or successful rate of a treatement 
>may be 80%. However it is an average; there are patients who 
>do better than that and there are patients who had worse 
>response.
>
>	The complication is more evident when we consider the 
>genetic make-up of an individual. It can be said that all 
>diseases have, either in small or large part, genetic 
>precipitation (and Diem Quynh will hit me for this).

***DQ: Anh TUan I agree with what you say about the gene and the 
treatment for each patient . That why we need the doctors' judment but 
cannot a robot !

 There is 
>no reason to believe that the treatment will work for all 
>patients in all genetic backgrounds. In fact, there have been 
>evidence showing that the efficacy of treatment is dependent 
>on the individual's interaction between genetic and 
>environmental factors. I mean, if once keeps smoking while 
>he/she has cancer of the lung, then treatment will not bring 
>a good result at all.

**** For exsample: The cancer(leukemia) drugs inhibite the proteins 
synthesis in patients; but the response of each patient to the cancer 
drugs is not the same! One of the side effects cause protein synthesis 
inhibition is the infections(no antibodies synthesis to fight back the 
infection) lack of many kinds of the proteins in the blood stream of the 
patients it may resulted the lack of platelet and non-coagulation of 
blood.....The patient in this treatment period has to be watch and base 
on the diagnostic results obtained by each case (patient's body response 
to the cancer drugs). 
>
>
>>Dear friends,
>>
>>Thank you, anh Son and other friends for the diagnostics of Phuong
>>Lien.
>>
>>Given the best current therapy, "standard-risk" childhood ALL 
>>(Acute Lymphoblastic Leukaemia) patients have a >70% long term
>>survival rate. The rate for the best prognostic group is around 80%.
>
>	I guess you have to tell us how long the "survival" is? 
>10 yrs or 20 yrs or more.

******DQ: Yes, I agree with anh Huy, but like anh Tuan's question .
 If the disese has no chance to be cured; I think we cannot find any
doctor or hospital; b/c the best way is  let patient to live with 
his/her family love, only God can help! 
 
>
>>I don't work in ALL, but a researcher in my dept says that 
>>Phuong Lien's white cell count is favourable and she has at least an
>>75% chance of long term survival.
>
>	This is a great news for her family. 

******DQ: Yes, with good medicine and suitable treatment can help the 
patient to increase a hope of survive.
>
>
>>Disclaimer: please remember the meaning and limitation of
>>statistics and don't use the above statistics irresponsibly.
>>
>>Huy
>
>	Wise comment!

 ***** DQ: Thank you for your general informations . 
I think the issue we are talking, somehow it reflect the macro and micro 
issue or the general issue vs individual issue in our life. 
       THanks
       DQ
>
>
>
>		Tuan Nguyen
>
>
>
>


_______________________________________________________
Get Private Web-Based Email Free http://www.hotmail.com