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Báo cáo y học: "Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the trut"

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JOURNAL OF MEDICAL CASE REPORTS Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth? Yitschaky et al. Yitschaky et al. Journal of Medical Case Reports 2011, 5:179 http://www.jmedicalcasereports.com/content/5/1/179 (13 May 2011)
Yitschaky et al. Journal of Medical Case Reports 2011, 5:179 JOURNAL OF MEDICAL http://www.jmedicalcasereports.com/content/5/1/179 CASE REPORTS EDITORIAL Open Access Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth? Oded Yitschaky1, Michael Yitschaky1 and Yehuda Zadik2,3* Abstract We are in the era of “evidence based medicine” in which our knowledge is stratified from top to bottom in a hierarchy of evidence. Many in the medical and dental communities highly value randomized clinical trials as the gold standard of care and undervalue clinical reports. The aim of this editorial is to emphasize the benefits of case reports in dental and oral medicine, and encourage those of us who write and read them. Editorial to read the Collins and Pinch report about how azi- We live today in the era of “evidence based medicine”, dothymidine was approved as effective treatment for Acquired Immune Deficiency Syndrome (AIDS), even in which our knowledge is stratified from top to bottom though the randomized clinical trials were stopped by in a hierarchy of evidence [1-3]. At the pinnacle of this the social and political pressure of AIDS activists [7]. hierarchy we find randomized clinical trials, systematic One of the methodological requirements of a rando- reviews and meta-analyses, which are supposed to be mized clinical trial is double blindness, which means the cream and cherry of medical-scientific-modern that both the patient and the physician do not know if knowledge. Far below at the bottom of the pyramid we that patient is receiving the treatment being evaluated find case reports, which are often barely regarded as evi- or a placebo substitute. In 1997, Shapiro and Shapiro dence. The aim of this editorial, however, is to empha- asked the question “How blind is blind?”, and claimed size the benefits of case reports, and encourage those of that in randomized clinical trials the doctor can differ- us who write and read them. entiate between true drug and placebo in about 80% of Randomized clinical trials are expensive, take years to the cases, and the patient can differentiate in about 70% conduct, and may encounter ethical problems, such as of the cases [8]. knowingly withholding treatment from a sample of The case report can be published quickly [9], and be patients. It is true that randomized clinical trials can authored by busy clinicians who see patients on a daily give us a statistical answer for very narrow clinical ques- tions, which can guide us when treating the “ average basis and do not have the time or money to conduct large patient” (i.e. the patient who comes with only the speci- scale research. In our humble opinion, the experience of these clinicians is valuable infrastructure on which medical fic medical problem). As clinicians we know that most knowledge can be built. Additionally, randomized clinical of our questions are not clearly answered in a rando- trials can only inspect one variable or very few variables at mized clinical trial, and many clinical questions cannot the most and rarely reflect the full picture of a complicated be answered. Clinical trials may be hindered by ethical medical situation. The case report can detail many differ- restraints [4], financial limitations, and statistical factors; ent aspects of the patient’s medical situation, specifically in some rare medical syndromes [5,6], it may be impos- including patient history, physical examination, psychoso- sible to collect adequate samples to conduct a rando- cial aspects, follow up, etc. mized clinical trial. With this in mind, it is interesting With regards to the question: “can the medical com- munity learn from one case? ” , our answer is that the * Correspondence: yzadik@gmail.com 2 Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, P.O. medical community must learn from any case, especially Box 91120, Jerusalem, Israel those that are particularly unusual. These cases will give Full list of author information is available at the end of the article © 2011 Yitschaky et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Yitschaky et al. Journal of Medical Case Reports 2011, 5:179 Page 2 of 2 http://www.jmedicalcasereports.com/content/5/1/179 us, as clinicians, better insight into the unusual riddles which we usually encounter in our everyday practice. Let us leave the “hierarchy” for the bureaucratic institu- tions and the “evidence” for the court-rooms, and use our imagination and intuition - which are well docu- mented in interesting case reports - to help us better treat our patients. Author details 1 Departments of Orthodontics, Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, P.O.Box 91120, Jerusalem, Israel. 2Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, P.O.Box 91120, Jerusalem, Israel. 3Editorial Board, Journal of Medical Case Reports. Authors’ contributions OY, MY and YZ conducted this Editorial together. Competing interests The authors declare that they have no competing interests. Received: 28 October 2010 Accepted: 13 May 2011 Published: 13 May 2011 References 1. Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ: User’s guides to medical literature: IX. A method for grading health care recommendations. JAMA 1995, 274:1800-1804. 2. Sackett DL: Evidence based medicine: what it is and what it isn’t. BMJ 1996, 312:71-72. 3. King M: Impact of participant and physician intervention preferences on randomized trials. JAMA 2005, 293:1089-1099. 4. Kidd MR, Hrynaszkiewicz I: Journal of Medical Case Reports’ policy on consent for publication. J Med Case Reports 2010, 4:173. 5. Will TA, Agarwal N, Petruzzelli GJ: Oral cavity metastasis of renal cell carcinoma: a case report. J Med Case Reports 2008, 2:313. 6. Lakshminarayanan V, Ranganathan K: Oral melanoacanthoma: a case report and review of the literature. J Med Case Reports 2009, 3:11. 7. Collins H, Pinch T: Dr. Golem - How to Think About Medicine. Chicago: The University of Chicago Press; 2005, 153-179. 8. Shapiro AK, Shapiro E: The power of placebo - from ancient priest to modern physician. Baltimore: John Hopkins University Press; 1997, 190-216. 9. Kidd M, Hubbard C: Introducing journal of medical case reports. J Med Case Reports 2007, 1:1. doi:10.1186/1752-1947-5-179 Cite this article as: Yitschaky et al.: Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth? Journal of Medical Case Reports 2011 5:179. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

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