Therapeutic priorities of Canadian internists

Abstract

We surveyed 175 members of the Canadian Society of Internal Medicine to determine how they would rank seven commonly used treatments as to their clinical usefulness. A total of 70% of the respondents judged that the treatment of severe hypertension was the most beneficial. Coronary artery bypass surgery and treatment with acetylsalicylic acid for transient ischemic attacks were ranked next most useful. Cholestyramine therapy for hypercholesterolemia, the treatment of mild hypertension, isoniazid therapy for inactive tuberculosis and carotid endarterectomy in patients with mild stroke formed the final cluster. Except for treatment of severe hypertension there was a wide variation in the physicians' enthusiasm for the various treatments. Possible explanations for this variation include physicians' lack of awareness of the results of clinical trials, the wide range of risk reductions found in various trials of the same therapy, an unwillingness by physicians to generalize from clinical trials to individual patients, individual physicians' placement of different values on the morbidity associated with various diseases, and the fact that physicians may rarely explicitly compare the usefulness of therapies. In general, the number of patients needed to be treated to save one life better reflected the physicians' judgements than did the relative risk reduction.