Table 1.

Examples of Inconsistency between Disease-Oriented and Patient-Oriented Outcomes

Disease Or ConditionDisease-Oriented OutcomePatient-Oriented Outcome
Doxazosin for blood pressure12Reduces blood pressureIncreases mortality in blacks
Lidocaine for arrhythmia after acute myocardial infarction13Suppresses arrhythmiasIncreases mortality
Finasteride for benign prostatic hypertrophy14Improved urinary flow rateNo clinically important change in symptom scores
Sleeping infants on their stomach or side16Knowledge of anatomy and physiology suggests that this will decrease the risk of aspirationIncreased risk of sudden infant death syndrome
Vitamin E for heart disease17Reduces levels of free radicalsNo change in mortality
Histamine antagonists and proton-pump inhibitors for nonulcer dyspepsia18Significantly reduce gastric pH levelsLittle or no improvement in symptoms in patients with nongastroesophageal reflux disease, nonulcer dyspepsia
Arthroscopic surgery for osteoarthritis of the knee15Improved appearance of cartilage after debridementNo change in function or symptoms at 1 year
Hormone therapy19Reduced low-density lipoprotein cholesterol, increased high-density lipoprotein cholesterolNo 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 mellitus20Keeps blood sugar below 120 mg/dL (6.7 mmol/L)Does not reduce overall mortality
Sodium fluoride for fracture prevention21Increases bone densityDoes not reduce fracture rate
Lidocaine prophylaxis after acute myocardial infarction22Suppresses arrhythmiasIncreases mortality
Clofibrate for hyperlipidemia23Reduces lipidsDoes not reduce mortality
β-blockers for heart failure24Reduce cardiac outputReduce mortality in moderate to severe disease