Examples of Inconsistency between Disease-Oriented and Patient-Oriented Outcomes
| Disease Or Condition | Disease-Oriented Outcome | Patient-Oriented Outcome |
|---|---|---|
| Doxazosin for blood pressure12 | Reduces blood pressure | Increases mortality in blacks |
| Lidocaine for arrhythmia after acute myocardial infarction13 | Suppresses arrhythmias | Increases mortality |
| Finasteride for benign prostatic hypertrophy14 | Improved urinary flow rate | No clinically important change in symptom scores |
| Sleeping infants on their stomach or side16 | Knowledge of anatomy and physiology suggests that this will decrease the risk of aspiration | Increased risk of sudden infant death syndrome |
| Vitamin E for heart disease17 | Reduces levels of free radicals | No change in mortality |
| Histamine antagonists and proton-pump inhibitors for nonulcer dyspepsia18 | Significantly reduce gastric pH levels | Little or no improvement in symptoms in patients with nongastroesophageal reflux disease, nonulcer dyspepsia |
| Arthroscopic surgery for osteoarthritis of the knee15 | Improved appearance of cartilage after debridement | No change in function or symptoms at 1 year |
| Hormone therapy19 | Reduced low-density lipoprotein cholesterol, increased high-density lipoprotein cholesterol | No decrease in cardiovascular or all-cause mortality and an increase in cardiovascular events in women older than 60 years (Women’s Health Initiative) with combined hormone therapy |
| Insulin therapy in type 2 diabetes mellitus20 | Keeps blood sugar below 120 mg/dL (6.7 mmol/L) | Does not reduce overall mortality |
| Sodium fluoride for fracture prevention21 | Increases bone density | Does not reduce fracture rate |
| Lidocaine prophylaxis after acute myocardial infarction22 | Suppresses arrhythmias | Increases mortality |
| Clofibrate for hyperlipidemia23 | Reduces lipids | Does not reduce mortality |
| β-blockers for heart failure24 | Reduce cardiac output | Reduce mortality in moderate to severe disease |