Hi everyone,
This is a brief summary of my presentation from today:
1950: Streptomycin, Smoking and Sir Austin Bradford Hill
Two unrelated events in 1950(discovery of a cure for tuberculosis and the discovery of smoking as a cause of lung cancer) seperated medicine's past from the coming future.
Before 1950, medical knowledge of causes and treatments of diseases was cumulative wisdom aquired through practice. Austin Bradford Hill changed all that and relied on statistical methods of proof, which became the sole 'scientific truth' after he proved the statistical method on the tuberculosis and lung cancer case. His incentive to run a randomised clinical trial on streptomycin and PAS was his own survival from tuberculosis. The objective is clear, he wanted to do a simple experiment where the efficiacy of a remedy is tested by comparing the outcome in those given it with that in a similar group who are not. Patients with similar age and disease pattern were located to the treatment or control group at random. Bradford Hill's findings were that a combination of streptomycin and PAS led to a 80% survival rate. Since the randomised Controlled Trial (RCT) became a standard way of evaluating new drugs.
He gave a epidemiological proof for the case whether smoking causes lung cancer. This proof involved collecting vital statistics over a certain period and observing the effects via a survey. He found that the dose relationship played a significant role as patients who consumed a higher dose of tobacco had a greater respond to lung cancer.
So, the RCT became the 'dominant' discourse of post-war medicine.
My Questions so far are:
-Is the 'objectivity' of the clinical trial or the RCT really better than the clinical wisdom of the doctor? do we really need these trials to test everything?
- as said in class: how do we randomise these trials? is it ethical?
so feel free to comment or answer, hav a gud weekend everyone...
