Medizin auf dem Prüfstand

Die meisten Menschen sind überrascht, wenn sie erfahren, dass es sich bei der rigorosen Anwendung formaler Beweisregeln zur Bewertung medizinischer Forschung und der Entscheidungsfindung hinsichtlich der besten verfügbaren Therapien um ein Phänomen jüngeren Datums handelt. Genauso überrascht könnten sie sein, dass die Gesundheitspolitik diesen Ansatz noch nicht verfolgt.

Die so genannte „evidenzbasierte Medizin“ beruht auf einer Rangordnung empirischer Nachweise, in der medizinische Studien aufgrund ihrer Qualität klassifiziert werden. Physiologische Forschung an Tieren oder die Erforschung der Reaktionen des menschlichen Körpers im Labor nehmen in dieser Rangordnung einen untergeordneten Platz ein. Beobachtungsstudien, in denen Ergebnisse von Patienten, die eine bestimmte Behandlung bekommen, mit den Resultaten von nicht behandelten Kontrollprobanden verglichen werden, rangieren zwar weiter oben, können aber trotzdem irreführend sein.

Wirklich überzeugende Studien zu Medikamenten und operativen Verfahren erhält man normalerweise nur durch randomisierte Studien, im Rahmen derer Patienten nach einem Zufallsverfahren, das dem Werfen einer Münze ähnelt, eine bestimmte Behandlung erhalten oder eben nicht. In gut durchgeführten randomisierten Studien sind auch zusätzliche Sicherheitsmaßnahmen gegen systematische Fehler (Bias) eingebaut, wie beispielsweise die Anwendung von Placebos, die es dem Untersucher ermöglichen, eine Studie durchzuführen, bei denen weder Patienten noch das medizinische Personal wissen, ob ein Patient tatsächlich aktiv behandelt wird oder nicht.

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