In our latest vlog, Anish and I discuss a thoughtful and well documented post by John Mandrola in which John rebukes the practice of using thrombolytic agents in acute stroke (“The Case Against Thrombolytic Therapy in Stroke.“). John’s post was itself prompted by a piece in the New York Times that is favorable to the use of the “clot-busting” treatment.
After posting our video, I was made aware of another post by an ER doc who, like John, is underwhelmed by the evidence in favor of thrombolytic therapy and, reflecting on the fact that numerous trials have tried to provide answers about the value of the treatment, asks “Why after 23 years do we still not know the answer?”
Of course, as readers of this blog know, my position is that RCTs are incapable of providing the answers that doctors seek (see, e.g., “The Devolution of Evidence-Based Medicine“).
Having expressed that opinion repeatedly here and on social media, I have been challenged by Professor Darrell Francis, professor of medicine at the UK’s National Heart and Lung Institute, and faculty at the Imperial College in London, to a debate (or, at least, a spirited discussion) that we will record and post on the channel.
This will happen in next week and should be really fun. Francis is a firebrand in the EBM movement, and has been principal investigator of several “game-changing” clinical trials.
Stay tuned, but meanwhile below is my discussion with Anish.