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Philip Sell

This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain. Philip Sell. What we have. Archie Cochrane. CONFOUNDING FACTORS. The Evidence. Level one Single study Quality of evidence Consort Grade.

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Philip Sell

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  1. This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain Philip Sell

  2. What we have

  3. Archie Cochrane

  4. CONFOUNDING FACTORS

  5. The Evidence • Level one Single study • Quality of evidence • Consort • Grade

  6. Systematic Review Meta-analysis

  7. Why the unease ? • Why is it some have no doubts • Why is it some have massive doubts?

  8. Medically unexplained symptoms

  9. Propioibacteriumfreudenreichii in Emmental cheese

  10. The reason we are uncomfortable DAILY EXPRESS Miracle cure for back pain: Agony ended by everyday antibiotics CHEAP antibiotics could end the agony of back pain for millions of Britons for ever.

  11. Press reports before peer acceptance • MMR studies • Steroids in cord injury • Hence our doubts

  12. Magical thinking in improvement

  13. Need for a science-based approach • Rigorous theory and methods • Fully specify interventions and mechanisms • How much evidence is needed

  14. Problem: childbed fever

  15. Vienna Maternity Institution: rates of puerperal fever 1841-1849

  16. Intervention was right; theory was wrong • The logic of hand-washing with chlorine was right (the technical intervention worked) • But the big theory of resorption of cadaveric particles was wrong • And the adaptive work was disaster

  17. Why we should wait for further evidence

  18. Original ArticleMagnetic Resonance Imaging in Follow-up Assessment of Sciatica Abdelilah el Barzouhi, M.D., Carmen L.A.M. Vleggeert-Lankamp, M.D., Ph.D., Geert J.Lycklama à Nijeholt, M.D., Ph.D., Bas F. Van der Kallen, M.D., Wilbert B. van den Hout, Ph.D., Wilco C.H. Jacobs, Ph.D., Bart W. Koes, Ph.D., Wilco C. Peul, M.D., Ph.D.,for the Leiden–The Hague Spine Intervention Prognostic Study Group N Engl J Med Volume 368 March 14, 2013 N Engl J Med Volume 368 March 14, 2013

  19. How it all began.....

  20. Conclusion • MRI performed at 1-year follow-up in patients who had been diagnosed with sciatica and a herniated disc on MRI …… did not distinguish between those with a favorable outcome and those with an unfavorable outcome

  21. Back pain’s association with vertebral endplate signal changes in sciatica Abdelilah el Barzouhi, M.D., Carmen L.A.M. Vleggeert-Lankamp, M.D., Ph.D., Bas F. Van der Kallen, M.D., Geert J.Lycklama à Nijeholt, M.D., Ph.D.,Wilbert B. van den Hout, Ph.D., Wilco C.H. Jacobs, Ph.D., Bart W. Koes, Ph.D., Wilco C. Peul, M.D., Ph.D.,for the Leiden–The Hague Spine Intervention Prognostic Study Group Eurospine 2013

  22. Backpain diminishes over time Evolution of back pain in surgicallytreated patientsaccordingto VESC Evolution of back pain in conservatively treatedpatientsaccordingto VESC

  23. The Trial • Unusual Control group show no change • Trial recruitment • Not spontaneous presentation • Trial entry Invite to attend to 347 patients known to the organisation. 162 recruited

  24. Harmless?

  25. Harmless? • MMR • Poor uptake of vaccines • Measles epidemic in Wales

  26. This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain MORE STUDY REQUIRED BE OPEN MINDED REJECT THE MOTION

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