Probar la medicina

La mayoría de la gente se sorprende cuando se entera de que la aplicación rigurosa de reglas formales de evidencia para evaluar la investigación médica y decidir cuáles son los mejores tratamientos es un fenómeno reciente. Tal vez se sorprendería de la misma manera si supiera que la política sanitaria aún no es objeto del mismo tratamiento.

La llamada "medicina basada en la evidencia" implica una jerarquía de pruebas empíricas que califica a los estudios médicos según su calidad. La investigación fisiológica en animales o de respuestas humanas en el laboratorio califican bajo en la jerarquía. Los estudios de observación que comparan resultados para pacientes que reciben determinados tratamientos y controlan a otros que no califican mejor, pero aún así pueden ser engañosos.

Los estudios convincentes de drogas y procedimientos quirúrgicos por lo general sólo surgen de pruebas aleatorias, en las que los pacientes reciben tratamiento o no en base a un proceso comparable a tirar una moneda al aire. Las pruebas aleatorias bien realizadas incorporan salvaguardas adicionales contra el prejuicio, como ser el uso de placebos que les permitan a los investigadores ocultarles a pacientes y profesionales de la salud si los pacientes están recibiendo o no un tratamiento activo.

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