Evaluating Treatment Products, A Doctors' Perspective
Medical Author: Dennis Lee, MD
Medical Editor: Melissa Conrad Stoppler, MD
Why do doctors recommend some health products or measures but not others?
Many of us are interested in taking steps to prevent diseases, stay
healthy, and to preserve and improve our quality of life. But
deciding what diets and nutritional products are best, and what medications to take is
not easy. There are a bewildering number of nutritional products and medications
that purportedly can prevent diseases and keep us healthy. While some of these
products have proven safety and effectiveness, many have not been subjected to
any scientific evaluation, and some are downright harmful. Increasingly, doctors
are being asked to advise patients on how to prevent diseases. However, the
medications and measures doctors recommend can be quite different from those
recommended by nutritionists, chiropractors, complementary or alternative health providers, etc.. What is the
reason for these differences? Why do doctors recommend some products but not
others? How do doctors determine whether a product is good or bad? How good are
doctors' recommendations? What are the doctors' weaknesses and limitations?
The process (steps) doctors commonly adopt in evaluating
any disease prevention medication or product is imperfect. And the resultant doctors'
recommendations are not always right (most of the recommendations in fact change
over time as more scientific evidence becomes available). But the process itself
is "honest"; it is there to minimize harm while trying to do some good.
How do doctors evaluate effectiveness and safety?
These are the questions doctors ask when evaluating a new health product,
medication, treatment, or prevention measure:
- Its effectiveness and safety have
been demonstrated by prospective, double blind, randomized, placebo-controlled
clinical trials? In prospective, double-blind, randomized, placebo-controlled
trials, patients who are similar in age, sex, genetic background, and other
characteristics such as health status, and diet are randomly assigned to
receive either the test medication or a placebo. The study has to be conducted
in a double blind fashion, meaning neither the patients nor the researchers
(those who are administering the drug or treatment)
know who is receiving the test medication or the placebo. At the end of the
trial, treatment results from the medication-treated group are compared to the
placebo-treated group to determine if the test medication is more effective
than the placebo. Randomly assigning study subjects and double blinding of
subjects and researchers are important to eliminate human bias from these
trials. Comparing test medications to placebo eliminates the placebo effect
- Its effectiveness and safety have been critically reviewed by independent experts?
Independent experts (not affiliated with the company manufacturing the product
or drug and who are not in a position to receive monetary gain from the
product) need to critically review the trial design, methodology,
results, and researchers' conclusions before the trial can be accepted for
publication in a reputable medical journal.
- Its effectiveness and safety
validated by other researchers? Having the trial published in reputable journals
is still not enough. Most doctors want to see validation (confirmation) of the
trial results by several independent research teams. There is comfort in
- How many subjects have been treated and for how long? Adverse side
effects of medications or products may not show up until a large number of
people have used the product over long periods of time.